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Among married women in the USA, 4% have experienced two clinical pregnancy losses and 3% three. The frequency of losses in human preimplantation embryos is very high. Of morphologically normal embryos, approximately 25-50% show chromosomal abnormalities, depending on maternal age. Luteal phase deficiency (LPD) has long been hypothesized, specifically due to inadequate progesterone secreted by the corpus luteum. Decreased conception rates and increased fetal losses are logically associated with overt hypothyroidism or hyperthyroidism. Only women with poorly controlled diabetes mellitus have increased risk for fetal loss. Leiomyomas plausibly could cause early pregnancy loss, but analogous to Müllerian fusion anomalies the coexistence of uterine leiomyomas and reproductive losses need not necessarily imply a causal relationship. An association between second- and third-trimester pregnancy loss and acquired thrombophilias is accepted, but the role thrombophilias play in first-trimester losses is less certain.
Power Doppler ultrasound (US), in combination with three-dimensional US and virtual organ computer-aided analysis (VOCAL), is a very good approach for investigating the global ovarian vascular network and its correlation with ovarian response in assisted reproductive technology (ART). An ovarian vascular map is easily obtained from a sagittal section of the ovary. Three-dimensional US has become a key tool for diagnosing uterine malformations. Leiomyomas and endometrial polyps are the most frequent benign uterine pathologies, and both can interfere with the reproductive process. The human endometrium undergoes intense angiogenesis during menstrual cycle, and angiogenesis is a key process for successful embryo implantation and development. In reproductive medicine, it is crucial to exclude ectopic pregnancy as early as possible. 3D US is a more accurate technique for evaluating the relationship between the gestational sac and uterine septum and for differentiating between a cornual pregnancy and a displaced intracavitary pregnancy.
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