title: Infertility and miscarriage: common pathways in manifestation and management.
abstract: The relationship between miscarriage and fertility is complex. While most healthcare settings treat miscarriage as a problem of subfertility in assisted reproduction units, others believe that miscarriage occurs in super-fertile women. Infertile women undergoing assisted reproduction are at a greater risk of having a miscarriage especially at an advanced age compared with women conceiving naturally. Aberrant expression of immunological factors and chromosomal abnormalities underlie both infertility and miscarriage. Common risk factors include increased maternal age, obesity, smoking, alcohol, pre-existing medical conditions and anatomical abnormalities of the reproductive system. Management pathways of both conditions may be similar with pre-implantation genetic testing and assisted reproductive technology used in both conditions. This paper discusses the synergies and differences between the two conditions in terms of their epidemiology, etiopathogenesis, risk factors and management strategies. The two conditions are related as degrees of severity of reproductive failure with common pathways in manifestation and management.
authors.affiliation: Department of Obstetrics & Gynaecology, University of Aberdeen Medical School, Foresterhill, Aberdeen, AB25 2ZD, UK.
authors.forename: Angena
authors.initials: A
authors.lastname: Agenor
authors.affiliation: Dugald Baird Centre for Research on Women's Health, Aberdeen Maternity Hospital, Cornhill Road, Aberdeen, AB25 2ZL, UK.
authors.forename: Sohinee
authors.initials: S
authors.lastname: Bhattacharya
mesh_terms: D000022:Abortion, Spontaneous / Q000453:epidemiology / Q000235:genetics / Q000276:immunology*; D000328:Adult; D000367:Age Factors; D000428:Alcohol Drinking / Q000453:epidemiology; D017152:Antibodies, Antiphospholipid / Q000378:metabolism; D002869:Chromosome Aberrations; D015897:Comorbidity; D016207:Cytokines / Q000378:metabolism; D005260:Female; D006680:HLA Antigens / Q000096:biosynthesis; D006801:Humans; D007247:Infertility, Female / Q000453:epidemiology / Q000235:genetics / Q000276:immunology*; D016023:Integrins / Q000378:metabolism; D007694:Killer Cells, Natural; D053605:Leukemia Inhibitory Factor / Q000378:metabolism; D018396:Mucin-1 / Q000378:metabolism; D009765:Obesity / Q000453:epidemiology; D011247:Pregnancy; D015995:Prevalence; D027724:Reproductive Techniques, Assisted; D012307:Risk Factors; D012907:Smoking / Q000453:epidemiology
chemical_list: D017152:Antibodies, Antiphospholipid; D016207:Cytokines; D006680:HLA Antigens; D016023:Integrins; D053605:Leukemia Inhibitory Factor; D018396:Mucin-1
keywords: advanced maternal age; assisted reproductive technology; infertility; miscarriage; recurrent miscarriage; spontaneous abortion; subfertility