Common Specialities
{{speciality.keyWord}}
Common Issues
{{issue.keyWord}}
Common Treatments
{{treatment.keyWord}}

Overview

Diva Fsh 75 IU Injection

Diva Fsh 75 IU Injection

Manufacturer: Bharat Serums & Vaccines Ltd
Medicine composition: Follicle Stimulating Hormone
Prescription vs.OTC: Prescription by Doctor required

Diva Fsh 75 IU Injection is used for stimulating a follicle (egg), allowing it to develop and then mature when a woman?s ovaries can produce the follicle but the hormonal stimulation is insufficient for maturing it. The medication is also used for stimulating the development of several eggs in case of in-vitro fertilization. Also, it can be used in treating the production of sperm in men. It is available in liquid form and has to be injected in the body. However, it must be noted that the medication can be of no help if the ovaries are incapable of producing an egg or if the testes are not able to produce any sperm.

Before using Diva Fsh 75 IU Injection, make sure that you do not have the following conditions:

  • Pregnant women should not use the medication as it can harm or lead to birth defects in an unborn baby
  • An untreated thyroid, adrenal gland or pituitary gland disorder
  • Abnormal or heavy vaginal bleeding that has remain untreated
  • Breast, ovary, uterus, testicle or pituitary cancer
  • An allergy to the ingredients present in the medicine

Diva Fsh 75 IU Injection is injected under your skin or in the muscle, generally under the supervision of a doctor. If you are self-injecting yourself, make sure you have the proper instructions regarding usage and dosage. Before starting with the medication, your doctor must be informed if you have conditions like asthma, polycystic ovary disease or a medical history of blood clot and stroke.

The mild side effects of Diva Fsh 75 IU Injection include headache, mild nausea, tingly feeling, runny or stuffy nose, swelling of the breast, mild pelvic pain or redness or irritation in the area where it has been injected. However, consult your doctor immediately if you face serious side effects such as:

  • Extreme pain in the lower stomach
  • Sudden weakness or numbness, especially in one side of your body
  • Less than normal urination
  • Swelling of the arms and the legs
  • An allergic reaction, symptoms of which include swelling of the face, hives, difficulty in breathing
  • Extreme pelvic pain on a particular side
Female infertility
This medicine is used for the treatment of infertility in women who are not able to ovulate, but no ovarian failure is detected. It may happen due to other diseases affecting the normal ovulation process.
Assisted reproductive technique
This medicine is used in combination with others to stimulate the production of multiple ovum which can be used for In vitro fertilization.
Male infertility
This medicine is also used in to treat male fertility by promoting the production of sperm cells.
Allergy
This medicine is not recommended for use if you have a known history of allergy to it or any other Gonadotropin hormonal preparations.
Primary ovarian failure
This medicine is not recommended for use in women who are not able to produce eggs due to ovarian failure. This is indicated by high level of follicle stimulating hormone in the body.
Hormonal disorders
This medicine is not recommended for use in patients who have hormonal disorder due to abnormal secretions from thyroid, adrenal glands or the pituitary.
Tumor
This medicine is not recommended for use in patients who have a tumor of the reproductive organs due to caused due to high levels of sex hormones. It should not be used for patients who have a tumor of the pituitary gland or the hypothalamus.
Abnormal uterine bleeding
This medicine is not recommended for patients who have an abnormal uterine bleeding and the cause is undetermined.
Ovarian Cysts
This medicine is not recommended for use in patients who have an ovarian cyst or enlargement which is of unknown origin and is not due to Polycystic ovary syndrome.
Primary testicular failure
This medicine is not recommended for treating infertility in men who are not able to produce sperm cells due to testicular failure.
In addition to its intended effect, Diva Fsh 75 IU Injection may cause some unwanted effects too. In such cases, you must seek medical attention immediately. This is not an exhaustive list of side effects. Please inform your doctor if you experience any adverse reaction to the medication.
Severe stomach ache Major Common
Bloating Major Common
Diarrhea Major Less Common
Severe nausea or vomiting Major Less Common
Pelvic Pain Major Less Common
Rapid weight gain Major Common
Heavy vaginal bleeding Major Rare
Unusual tiredness and weakness Moderate Less Common
Increased blood pressure Moderate Less Common
Depressed mood Moderate Less Common
Fever Minor Rare
Severe skin allergy Major Rare
How long is the duration of effect?
The effect of this medicine lasts until the end of the ovulation cycle.
What is the onset of action?
The effect of this medicine is cumulative and can be observed when ovulation happens.
Are there any pregnancy warnings?
Use of this medicine is not recommended for women who are pregnant as the risk of birth defects and abnormalities in the newborn is very high. Consult your doctor regarding the risks associated with the use of this medicine during pregnancy.
Is it habit forming?
Are there any breast-feeding warnings?
Use of this medicine by women who are breastfeeding is not recommended. If it becomes absolutely necessary to use this medicine, then breastfeeding should be discontinued. Consult your doctor regarding the risks associated with use while nursing an infant.
Below is the list of medicines, which have the same composition, strength and form as Diva Fsh 75 IU Injection, and hence can be used as its substitute.
Zydus Cadila
Intas Pharmaceuticals Ltd
Sun Pharma Laboratories Ltd
Serum Institute Of India Ltd
Delvin Formulations Private Ltd
Missed Dose instructions
Contact your doctor for further instructions if you have missed a scheduled dose of this medicine.
Overdose instructions
Contact your doctor if an overdose with this medicine is suspected.
India
United States
Japan
Whenever you take more than one medicine, or mix it with certain foods or beverages, you're at risk of a drug interaction.
Interaction with Disease
Disease
Information not available.
Interaction with Alcohol
Alcohol
Interaction with alcohol is unknown. It is advisable to consult your doctor before consumption.
Interaction with Lab Test
Lab
Information not available.
Interaction with Food
Food
Information not available.
Interaction with Medicine
Ganirelix Moderate
Report the use of ganirelix to the doctor before receiving follicle stimulating hormone. You may need a dose adjustment and a set of tests to determine the safety and efficacy of use. Do not stop the use of any medicine without consulting your doctor.

Popular Questions & Answers

Is it necessary to have surgery for gynecomastia? gynecomastia is related to infertility?

MBBS, MS - General Surgery, FIAGES(Fellowship In Minimal Access Surgery), FMAS (Fellowship In Minimal Access Surgery)
General Surgeon, Ghaziabad
Hi. It's not necessary to undergo surgery. The usual indication for surgery is cosmetic purpose. See bilateral gynecomastia is indicative of testicular dysfunction. For that you can undergo ultrasound scrotum and blood test for serum FSH, LH, Prolactin and testosterone levels. Thanks.
1 person found this helpful

I am suffering from low zero sperm count and my lh and fsh is high so doctor has given me tablet ferteez twice in a day and wysolone 5 half in night. Will it help to improve my sperm count.

BASM, MD, MS (Counseling & Psychotherapy), MSc - Psychology, Certificate in Clinical psychology of children and Young People, Certificate in Psychological First Aid, Certificate in Positive Psychology
Psychologist, Palakkad
I am suffering from low zero sperm count and my lh and fsh is high so doctor has given me tablet ferteez twice in a d...
Dear lybrate user. I can understand. Don't get confused. SEMEN COLOUR, QUANTITY AND THICKNESS changes according to physical condition and sexual intercourse / masturbation timing and related mental and physical conditions. Therefore, don't think too much about the thickness or quantity of sperm. If you want to know the quality of sperm, get your sperm checked for that. For Healthy Sperm, Eat More Vitamins.(Deficiencies in vitamin A have been linked to sluggish sperm and lowered fertility) Minerals.(Inadequate levels of zinc can cause lowered sperm counts), Fatty acids, Folic acid, Lycopen, and Drink a lot of Water. Include sprouts in your daily diet to improve sperm count and quality. Take care..

I am 45 years old. My latest lower abdomen scan report shows Uterus -Anteverted, LS: 6.2 cm TS: 8.0 cm LMP: 1 years 9mons, EM: Atrophic, Right ovary: Visualised LS: 1.8 cm TS: 1.5 cms Left ovary: Visualised LS: 1.3 cm TS: 1.4 cms cough of Douglas: No free fluid in the child sac. Comments: small calcified fibroids seen. I want to know whether I attained menopause completely. Am I pregnant now? Please answer these 2 questions:

MD - Obstetrtics & Gynaecology, MBBS, Diploma in Clinical ART ( Infertility)
Gynaecologist, Ghaziabad
I am 45 years old. My latest lower abdomen scan report shows Uterus -Anteverted, LS: 6.2 cm TS: 8.0 cm LMP: 1 years 9...
Hello, 1. No bleeding for one month is a retrospective diagnosis of menopause. EM atrophic also points towards the same. If you want further evidence you may get a FSH done, though its not recommended. 2. Highly unlikely.

What is the reason for infertility. My wife's all test normal FSH, LH, prolactin, TSH, AMH, even HSG Also but we can't be success to fertilization. We try through IUI but same failed with own sperm and from sperm bank.

Advance BHRT Certification, Fellowship in BHRT & Longevity Medicine, Fellowship in Endocrinology, MBBS
Endocrinologist, Bangalore
What is the reason for infertility. My wife's all test normal FSH, LH, prolactin, TSH, AMH, even HSG Also
but we can'...
The fact that your wife could not conceive even from donor sperm indicates that there is a primary reason in her for infertility. Even if the tests are "Normal" they may not be "optimal" In your case, I would undertake a detailed Endocrine evaluation and optimize the relate hormones and nutrients to facilitated conception. I prefer to use bioidentical hormones whenever require. The process usually takes 3 to 6 months.

Popular Health Tips

Ovulation - Understanding Ovulation Cycles!

MBBS, MS-Obstetrics & Gynaecology
Gynaecologist, Delhi
Ovulation - Understanding Ovulation Cycles!

The cyclical change in the uterus and ovaries of the female reproductive system is called the menstrual cycle. It includes changes in the physiology of the uterus along with the change in hormones as well. This cyclical change is what allows a woman to get pregnant. This cycle allows the formation of ovocytes and helps to prepare the uterus for implantation.

The commencement of period is called the menarche. It normally starts from the age of twelve to fifteen years. The time between the first day of the period and the first day of the next one is usually twenty one to forty five days in young adults and twenty one to thirty five in older women. The entire cycle is mainly governed by hormones like oestrogen, progesterone, Luteinizing Hormone etc.

Hormonal changes play a big role in the menstrual cycle. It consists of three phases

  • Menstrual stage (1-7 days)
  • Proliferative stage
  • Secretory stage

In the menstrual stage, the thick endometrial lining of the uterus will start to shed and will come out of the vagina in the form of blood and mucous. This may last from four to seven days. The levels of both progesterone and estrogen remain low in this phase.

In the second stage, i.e, the proliferative stage, the amount of oestrogen gradually rises and the menstrual flow reduces and eventually stops. The Follicle stimulating Hormone (FSH) is produced in the brain that stimulates your ovaries to produce mature eggs. The eggs are present in a follicular bag, which allows the secretion of oestrogen. Hence the amount of oestrogen is the least on the first day and increases gradually. At the same time, the uterine lining starts to thicken. This is the phase in which the egg is produced and in the presence of sperm, gets fertilised.

You may notice a thin slippery discharge around these days that makes it easier for the sperm to travel and survive in the uterus. You are most fertile in this stage, around on the 14th day of the cycle when ovulation occurs. The egg survives for around 24 hrs, whereas sperm can survive for about 2-3 days.

In the secretory phase, if the egg is not fertilised, the levels of oestrogen and progesterone fall. The thick lining that has been produced starts to shed and that commences the menstruation. If the egg is fertilised, then it may implant itself to the uterine wall and produce the pregnancy hormone called human Chorionic Gonadotropin (hCG). If you wish to discuss about any specific problem, you can consult a Gynaecologist.

4615 people found this helpful

Know About Delayed Puberty

MD - General Medicine, DM - Endocrinology, MBBS
Endocrinologist, Delhi
Know About Delayed Puberty

Puberty results from activation of gonads (testes in boys/ ovaries in girls) by pituitary hormones LH and FSH. Activated gonads produce sexual hormones (testosterone in boys and estrogen in girls ) which are responsible for gender specific physical changes at puberty along with behaviour changes. Testosterone in boys is responsible for hair growth over pubic area and face with maturation of genital organs, breaking of voice, development of muscular and skeletal system. Similarly, estrogen in girls is responsible for breast development, maturation of genital organs with feminisation of body. Bone maturation with rapid height gain is seen at puberty both in boys and girls. Various systemic and hormonal disorders can result in either late or early puberty. 

LATE PUBERTY - 

Most of the boys show signs of puberty latest by age of 14 years and most girls start showing signs of puberty latest by age of 13 years. The earliest sign of puberty in boys is enlargement of testes and in girls is height spurt/breast development. When boys older than 14 years and girls older than 13 years don't have any signs of puberty it is called delayed puberty. 

CAUSES OF DELAYED PUBERTY - 

  1. Constitutional delay is most common cause of delayed puberty. The constitutional delay means child is not having any illness and he is going to develop puberty spontaneously at later age. But diagnosis of this condition can be made only after physical examination and investigations so that other causes of delayed puberty are ruled out. 
  2. Functional hypogonadotropic Hypopogonadism - Delayed but spontaneous puberty develops. This condition can be seen in systemic illnesses like chronic infections, poor nutritional status etc. 
  3. Hypogonadotropic Hypogonadism - Disorders of pituitary gland result in low LH and FSH so that testes/ovaries are not stimulated and sex hormone is not produced. This can be caused by various genetic disorders, brain tumours, head injury, brain radiation etc. 
  4. Hypergonadotropic Hypogonadism - In this scenario, LH and FSH levels are normal but gonadal are not able to produce sex hormones resulting in delayed puberty. 

CONSEQUENCES OF DELAYED PUBERTY - 
The absence of age specific pubertal changes cause anxiety and distress in children and their parents. These children may develop low self-esteem and are teased by their peers. Along with the poor development of physical signs of puberty, fertility is also affected in hypogonadism. And most importantly, delayed puberty can be the symptom of serious underlying illness like intracranial tumours etc. These children deserve medical attention to get best results. 

INVESTIGATIONS - 
Serum testosterone/estradiol with LH and FSH is done to find out where is defect i.e. whether at the level of pituitary gland or at the level of testes/ovaries. Further investigations depend on levels LH, FSH, estradiol/testosterone. Other useful investigations include prolactin, T4, TSH, ray hand for bone age, ultrasound pelvis, MRI pituitary gland etc. 

TREATMENT - 
After diagnosis is established, Testosterone/estrogen replacement should be started to boys older than 14 year and girls older than 13 years respectively. Hormone replacement is very effective and usually safe. In adulthood those with hypogonadotropic hypogonadism can be treated with LH and FSH to produce sperms/ eggs so that they can achieve fertility. If you wish to discuss about any specific problem, you can ask a free question.

2950 people found this helpful

PCOS

M.Sc Dietetics and Food Service Management, B.Sc. - Dietitics / Nutrition
Dietitian/Nutritionist, Hubli-Dharwad

Pcos is a hormonal disorder affecting many women leading to abnormal weight gain, high sugar levels and infertility. It is said even a 10% reduction in weight improves the overall condition in pcos. Losing weight is the only way to manage pcos and diet plays an 80% role in the same. Balance nutrition offers this online program for weight loss for women with pcos. Along with the diet, special super foods from the kitchen are incorporated to ensure you lose weight, correct the hormonal imbalance and regularize periods

What is pcos diet?

A typical low-fat weight loss diet like the simple 1200 calorie diet plan is not effective enough to promote weight loss in women suffering from pcos because in this case, weight gain is a result of high insulin levels that promotes fat storage in the body. Polycystic ovaries treatment and weight management call for a specialized low gi diet that includes selected combinations of foods that don't cause a rapid rise in blood glucose levels.

6 healthy food groups to include in a pcos diet menu

The following is a healthy pcos food list that can be included in the daily diet in order to manage the polycystic ovarian disease in a more effective manner and prevent weight gain which is one of the most recognizable symptoms of this condition.

Green leafy vegetables

The benefits of eating fruits and vegetables to lose weight are well known, but it also helps to control polycystic ovary syndrome naturally. Leafy vegetables have maximum nutrients per calories compared to other foods and also rich in calcium, iron, potassium, magnesium along with vitamins k, c and e and most importantly essential b vitamins which plays an imperative role in managing the symptoms of pcos. B vitamins especially b2, b3, b5 and b6 help in better sugar and fat metabolism, improve thyroid functioning and render better hormone balance, improve fertility all of which are essential for pcos management.

Green leafy vegetables for pcos

The minerals help to neutralize the acidity caused by inflammation and impaired glucose tolerance. Calcium helps in egg maturation and follicle development in ovaries; potassium is needed for fsh (follicle stimulation hormone) production. It helps to reduce pms symptoms and also promotes weight loss.

Coloured vegetables

Brightly colored vegetables not only makes for an appetizing salad but also helps in controlling pcos and must be included in the pcos diet plan. Colourful vegetables are loaded with powerful antioxidants that help to neutralize the harmful effects of oxidative stress in women suffering from pcos. Coloured vegetables

Some of the healthiest colored vegetables include red and yellow bell peppers, sweet potatoes, tomatoes, carrots, eggplant, etc.

Fruits

This is the next set of healthy foods that must be included in pcos diet recipes. Although most women suffering from pcos are reluctant to include fruits in their diet because of the fructose content that causes a sudden spike in blood sugar levels and consequently insulin levels, fruits are really rich in phytonutrients, vitamins, minerals and fibres so it should not be avoided entirely.

Fruits and vegetables

Include fruits that have low gi such as lime, strawberries, apricot, grapefruit, lemon, cantaloupe, guava, pear, oranges, watermelon, blueberries, nectarines, apples and kiwifruit and also eat a handful of nuts or seeds with the fruits for the much needed protein boost that helps to control the sudden sugar spike caused by fruits. You can also try delicious kiwi smoothie recipes which are loaded with nutrients.

How to make your menstrual cycles regular- 8 simpke ways

MBBS (Gold Medalist, Hons), MS (Obst and Gynae- Gold Medalist), DNB (Obst and Gynae), Fellow- Reproductive Endocrinology and Infertility (ACOG, USA), FIAOG
Gynaecologist, Kolkata
How to make your menstrual cycles regular- 8 simpke ways

How to make your menstrual cycles regular?

First, you should know what is meant by the word 'irregular'? In most women period movers at an interval of 28 to 30 days. But it is said to be normal if it happens every 21-35 days. That means you should have periods not more frequently than every 3 weeks or not less frequently than every 5 weeks. But if you had previous cycles at an interval of every 4 weeks but now you are having periods every 5 weeks, that is ABNORMAL, although it is occurring every 35 days. In other words, change in interval up to 7 days is normal, nit beyond that. For example, if you had periods every 30 days previously and for last 2 months it is happening every 33 days or every 25 days, then it's normal. But if it happens at an interval of more than 37 days (30 + 7) or less than 23 days (30- 7) then it's, of course, abnormal.

So what are the things you can do for regular periods?

1. Normal weight
Ideal weight varies according to the height. We express it in terms of BMI (Body Mass Index) that is the weight in Kg divided by the square of the height in centimeters. Ideal BMI should be between 19 to 25. If it's more than 25, reduce weight by diet and exercise. IT can resume normal menstruation without any drugs. IF despite your sincere efforts, you are unable to lose weight or even after normalization of weight menstruation remains irregular, you must consult your gynaecologist for treatment.
On the other hand, very low BMI can also cause irregular menses. Treatment is weight gain. This is often seen in athletes and they are even at the risk of losing bone calcium because if excessive exercise and strict diet control. If gaining weight does not help, you must consult your doctor for having regular periods.

2. Stress, Anxiety, Tension, Depression
These are an inevitable part of modern lifestyle. These may not only cause mental problems but will also cause physical problems by altering the hormone levels. The result is an abnormal menstrual cycle. Try to avoid them by relaxation, counseling and if necessary by taking help of doctors.

3. Thyroid disorders
The problem of the thyroid gland is common in females and causes abnormal weight and changes the action of many hormones. The result is irregular menstruation. So if you feel lethargy, extreme cold, weakness or increased weight, do not forget to check thyroid status after consulting a doctor.

4. Pituitary disorders
The pituitary gland is a gland situated inside the brain that controls hormone of other glands of the body. If there is soMe tumour or soNe abnormalities in its function, there will be high level of prolactin hormone secretion or there will be a deficiency of hormones like FSH and LH. As a result, ovaries cannot produce enough hormones and you will have irregular menstruation. So in the case of abnormal menstruation, please Check your prolactin level.

5. PCOS
Polycystic Ovarian Syndrome is common nowadays. Apart from causing abnormal menstruation, it increases the risk of infertility, high blood pressure, diabetes, heart disease and even cancer. It is diagnosed by clinical features, hor tests and ultrasonography. It may also cause weight gain, male like the growth of hairs in body and oily skin. The treatment is weight control and drugs to regularize menses. This is particularly important in young women teenagers, in whom timely treatment can prevent many serious consequences.

6. Premature Ovarian Failure
In some women, menopause can come earlier and irregular menstruation may be the early indication of this. This may be followed by permanent cessation if periods. So if you are planning for family expansion but have irregular menses, do not delay pregnancy.

7. Problems in uterus
Excessive trauma to the uterus by repeated surgical abortion or infections like STD are tuberculosis can damage the lining of the uterus. The result is irregular menses followed by total cessation of menses. But this problem can be easily treated if you consult your gynecologist in time.

8. Systemic diseases and drugs
Irregular menSes should never be ignored. Sometimes it may be because if so e undiagnosed diseases like diabetes, diseases if heart, liver, kidney, chest etc. Often it may be the side effect if the drugs you are taking- like antacids containing domperidone, psychiatric drugs, Steroids or chemotherapy.

In conclusion, irregular menstruation may sometimes warn you about serious diseases and may be associated with infertility and early menopause. Stay healthy, have healthy diet and lifestyle, maintain a normal weight, get rid of tension and attend your doctor's clinics in time.

37 people found this helpful

Repeated Miscarriage- A Painful experience for the couples

MBBS (Gold Medalist, Hons), MS (Obst and Gynae- Gold Medalist), DNB (Obst and Gynae), Fellow- Reproductive Endocrinology and Infertility (ACOG, USA), FIAOG
Gynaecologist, Kolkata
Repeated Miscarriage- A Painful experience for the couples

Pregnancy gives a woman completeness by turning her into mother from a simple woman. It is the thing which makes the couple parents, the dream which they nurture right time from their marriage. Of course there are many couple s who are not fortunate enough to achieve pregnancy and they are usually termed infertile and we have discussed it in separate post. But there are other couple s who may or may not (as this is the usual case) find difficult to conceive but the pregnancy does not continue to the age of viability. Age of viability means the age, when a baby born can survive. Thanks to the improvement in neonatal care by leaps and bounds and availability of NICU which made it possible to survive even a baby born at 22 weeks. For example last month we delivered a baby at 28 weeks of pregnancy, who is fine now. But if the baby is 'born' before 20 weeks, it is called MISCARRIAGE. This is because these babies who weigh less than 500 gram cannot survive outside the uterus. It is seen that 10-15% couples who conceive successfully may not be able to carry pregnancy beyond 20 weeks. Thus the miscarriage rate for a single pregnancy is 10-15%. But in most of the time this mishap does not recur in future. We call it 'sporadic miscarriage' and often the cause is not known. But almost 1% of the couples who wamt to get pregnant may suffer from repeated miscarriage. That means the unfortunate events can repeat. These are called 'RECURRENT MISCARRIAGE' or 'REPEATED PREGNANCY LOSS *RPL).

CAUSES

So, what's the reason for RPL which is equally frustrating for the patients as well as the doctors? First of all let me honestly confess that in most of the cases the cause is not known (50-60%) and this is called 'UNEXPLAINED RPL'. Again we have to admit that despite tremendous advancement in science, the knowledge behind RPL is limited. Many theories and causes have ben proposed but most of them could not withstand the taste of time. That means if a problem is found in husband or wife, we are not certain whether the treatment of that problem will prevent future miscarriage. This should be explained properly to the couples to have realistic expectations and avoid unnecessary frustration s in future. Only factors which are definitely associated with RPL are only two- anti-phospholipid antibody syndrome (APS) and chromosomal problem of either of the couples. Detection and treatment of these problems are often rewarding as after treatment pregnancy continuation rate us very high. The other causes have been proposed but as mentioned above the link between RPL and these causes are not yet very clear and need further scientific research. Please remember according to the timing, RPL may be divided into two categories- the 1st trimester RPL (occurring before 12 weeks in each pregnancy) or second trimester RPL (12-20 weeks in each pregnancy).

4-5% cases may be due to genetic or chromosomal problem of the couples. These problems can affect the egg (ovum) and/or the sperms. Even if the couples are normal, the baby may have abnormal chromosome.It is blessing that a genetically abnormal baby is miscarried by the nature, otherwise if it survives there is high chance that it may be mentally or physically handicapped. The reason may be increased age of the mother (above 35 years especially), exposure of mother to some environmental pollutants or sometimes increased age of the father (the latter is controversial). The diagnosis is done by chromosomal analysis of the couple by Karyotyping or FISH from blood samples. If the baby has been miscarried, it may be rational to send the tissue of the baby for chromosomal analysis to find iut the cause. The treatment option in next pregnancy in such cases is genetic counseling by an expert and in most cases unfortunately ine option remains- that us IVF and PGD (pre implantation genetic diagnosis) where only genetically tested normal embryos are transferred by IVF ('test tube baby').

Anatomical factors are responsible for 12-15% if RPL, in most cases the second trimester RPL. The most common cause is 'CERVICAL INCOMPETENCE'. The cervix is the mouth of the uterus which should remain closed in pregnancy to support pregnancy and should only open during delivery. But in some cases it xan open prematurely leading to miscarriage. Usually this causes apparently painless miscarriage. In many women fibroid is found as a tumour of uterus. Whether fibroids cause RPL is again very controversial among the scientists and doctors. In some women who had repeated abortion or surgery to uterus and even tuberculosis (TB) there may be adhesion (binding together) between the walks of uterus. This is called Asherman Syndrome which causes scanty or absent periods and RPL. In few women there may be Congenital Anomaly of the uterus- that is yhere is some abnormalities inside uterus from birth. Thesr xan sometimes caus RPL, although controversial. These anatomical problems are diagnosed by proper examination, some tests like HSG (hystero salpingogram), SSG (sono salpingogram), 3D ultrasonography (USG), MRI, hysteroscopy and/or laparoscopy, depending on the women and test results. The treatment should be dobe cautiously as treatment may not always prevent RPL. For cervical incompetence usually we put stitch in the cervix in pregnancy or sometimes before pregnancy. Operation xan be done, before pregnancy for fibroids, Asherman and congenital anomalies.

In many cases (more than 70%) cases hormonal problems may be there and these may cause both 1st and 2nd trimester RPL. However whether treatment us beneficial or not, is again controversial. The commonest pattern is Luteal Phase Deficiency (LPD) due to deficiency of hormone progesterone. PCOS (Polycystic Ovaries) is also asdociated with RPL. The other causes are uncontrolled diabetes, thyroid problems, high prolactin and high testosterone, high insulin and low ovarian reserve. As mentioned earlier, it is not clear whether they all need testing and treatment but usually tests advised for these are blood for progesterone, TSH, Prolactin, FSH, LH, AMH, Insulin, Testosterone, sugar, HbA1C etc. Treatment is usually progesterone supplement along with correction of hormonal imbalance. It is to be mentioned that these patients need high dose of thyroid drugs (TSH normal for other people may be considered abnormal for RPL) and more tight control of blood sugar in diabetes.

In 60-70% cases the cause Thrombolphilia, that is tendency to thrombosis or blood clotting. The most common is  anti phospholipid antibofy syndrome (APS) which nay or may not be associated with thrombosis in other sites but can cause thrombosis if blood supply to the baby and thus causes stopage of its heart and miscarriage. Although more common in the Western World, some Hereditary Thrombolphilia may be found in other family members and commonly cause miscarriage and thrombosis. Deficiency of folic acid and vitamin B12 rarely xan cause thrombosis and RPL. The APS testing is often successful, so as the treatment with aspirin and heparin injection throughout pregnancy. With this 80% women can expect full term pregnancy. Folic acid and B12 vitamin supplement is commonly given to RPL patients. Whether testing for hereditary thrombophilia is needed in our country ir not is controversial. But treatment is like APS- that is aspirin and heparin injection.

Diseases of mother like diabetes, epilepsy, liver or kidney diseases, SLE etc can cause miscarriage. Exposure of mother to harmful substances like environmental pollution, radiation, chemotherapy and some toxic drugs, smoking, alcohol, cocaine, cannabis etc are alse responsible but the latter usually cause sporadic miscarriage rather than RPL. So these drugs should be stopped and replaced by safer drugs anf the diseases mudt be treated properly. Even exposure of father to some drugs can cause RPL. Again some abnormalities of sperms may cause RPL. So, semen analysis of the husband is usually done as a test for RPL.

The most controversial topic for RPL is the infections. But itbis the fact proved by scientific studies that only infection in current pregnancy causes miscarriage. So infection is a cause of sporadic miscarriage, not RPL. In the past TORCH testing was very much popular but nowadays it is obsolete test and there is no scientific ground for tests or treatment of TORCH. Only test we recommend is rubella testing. If rubella IgG is negative that means you may get infection in pregnancy so we advice to take rubella vaccine and avoid pregnancy for one month. On the other hand, rubella IgG positive neans you are already imune and thus you can never get rubella. So vaccine is not useful in those cases. If any genital infection is found in husband or wife, both if them should be tested and treated aggressively.

TESTS REQUIRED

First of all we ned to know when we should advise tests. Assuming that most cases of miscarriages are SPORADIC, we usually di not advise investigation after single miscarriage unless the couple insists or there is some reason by the doctor to suspect some abnormalities that might cause future miscarriage. In the past testing was started after 3 miscarriages. But nowadays we do not want to give the couple, especially the woman a third trauma. So we usually advise tests after 2nd miscarriage. The tests usually start with checking for chromosome of the baby. It is followed by chromosome analysis of both the partners along with proper history taking and physical examination. Semen analysis us fone for the husband. The wife is advised ultrasonography, routine blood, thyroid testing, testing for APS and blood group. These are tests usually dine everywhere. Further tests are done depending on the results if initial tests ans0d especially if no cause us found after initial tests. It should be mentioned to the couples that the 2nd group if tests often do not have scientific grounds and are done only on benefit of doubt. They may not change the management plan. TORCH test is not done in modern era.

TREATMENT

The basic treatment is support if the couples, reducing stress as stress can be responsible for RPL. When a cause is found this should be treated. While an optimistic approach should be taken with expectations for normal pregnancy in future but this should be based on scientific and realistic approach to avoid future frustration. The treatment may not be 100% effective and most treatment may not have scientific base but are usually not harmful. Treatment may not guarantee a successful future pregnancy but a positive attitude is necessary. This is called TENDER LOVING CARE (TLC where proper support and discussion can help more than explanation if mere statistics. Treatment should be continued both before and after pregnancy confirmation, as mentioned above. This isbto be mentioned thst even after 6th miscarriage, the chance that future pregnancy will be normal is more than 50%. So, the message should be not to give up hope.

28 people found this helpful