We studied the risk of early loss of pregnancy by collecting daily urine specimens from 221 healthy women who were attempting to conceive. Urinary concentrations of human chorionic gonadotropin (hCG) were measured for a total of 707 menstrual cycles with use of an immunoradiometric assay that is able to detect hCG levels as low as 0.01 ng per milliliter, with virtually 100 percent specificity for hCG in the presence of luteinizing hormone. Our criterion for early pregnancy--an hCG level above 0.025 ng per milliliter on three consecutive days--was determined after we compared the hCG levels in the study group with the levels in a comparable group of 28 women who had undergone sterilization by tubal ligation. We identified 198 pregnancies by an increase in the hCG level near the expected time of implantation. Of these, 22 percent ended before pregnancy was detected clinically. Most of these early pregnancy losses would not have been detectable by the less sensitive assays for hCG used in earlier studies. The total rate of pregnancy loss after implantation, including clinically recognized spontaneous abortions, was 31 percent. Most of the 40 women with unrecognized early pregnancy losses had normal fertility, since 95 percent of them subsequently became clinically pregnant within two years.

https://www.nejm.org/doi/pdf/10.1056/NEJM198807283190401

Incidence of Early Loss of Pregnancy

A methodical gross examination should be undertaken in all births and the results incorporated in the patient’s record.

The Pathology of the Human Placenta

The implantation of fertilized ova and the formation of the placenta are crucial steps in reproduction. This review summarizes current information about these steps, including some of the molecular mechanisms that mediate them and how they may go awry, with consequent loss of the pregnancy.

Implantation and the survival of early pregnancy.

Background Implantation of the conceptus is a key step in pregnancy, but little is known about the time of implantation or the relation between the time of implantation and the outcome of pregnancy. Methods We collected daily urine samples for up to six months from 221 women attempting to conceive after ceasing to use contraception. Ovulation was identified on the basis of the ratio of urinary estrogen metabolites to progesterone metabolites, which changes rapidly with luteinization of the ovarian follicle. The time of implantation was defined by the appearance of chorionic gonadotropin in maternal urine. Results There were 199 conceptions, for 95 percent of which (189) we had sufficient data for analysis. Of these 189 pregnancies, 141 (75 percent) lasted at least six weeks past the last menstrual period, and the remaining 48 pregnancies (25 percent) ended in early loss. Among the pregnancies that lasted 6 weeks or more, the first appearance of chorionic gonadotropin occurred 6 to 12 days after ovulation;...

Time of implantation of the conceptus and loss of pregnancy.

Why do females across a wide range of taxa mate with more than one male? We suggest that a better understanding of polyandry may be gained by considering the implications of intragenomic conflict for female reproductive success. Here, we revisit the literature on cellular endosymbionts, transposable elements, segregation distorters, maternal-effect lethals and genomically imprinted genes to show that each of these selfish genetic elements can modify maternal and paternal haplotypes in ways that render them incompatible within the developing embryo. We propose that the cumulative threat to female reproductive success of genetic incompatibility arising from intragenomic conflict may be an important force driving the evolution of polyandry. By mating with more than one male, females can potentially exploit post-copulatory mechanisms for minimizing the risk and/or cost of fertilization by genetically incompatible sperm. This hypothesis differs fundamentally from other genetic benefit models of polyandry in that the fitness consequences of intragenomic conflict depend on an interaction between parental genomes and are thus non-additive. Reciprocal evolutionary change between selfish genetic elements and their suppressors, combined with the capacity of these elements for horizontal transfer between species, is likely to ensure the persistence of genetic incompatibility as a threat to female reproductive success.

The evolution of polyandry I : intragenomic conflict and genetic incompatibility

From a study of 34 early human ova (24 normal and 10 abnormal) recovered from a series of 107 patients known to be fertile whose conditions for conception were optimal it appears that the maximum fertility rate at implantation is 58%; the maximum normal fertility rate after the twelfth day of ovular development is 42%; the probable maximum fertility rate during the preimplantation stages is from 80 to 90%; the greatest ovular loss is in the preimplantation stage; the next greatest loss is during the week after implantation; the ovular loss after the first missed period may be as great as 28.6%, either with or without clinical signs and is therefore comparable to the clinical abortion rate; these defective human fertilized ova rise because of intrinsic defects rather than from defects of the local or endocrine environment, and, finally, the fertility rates and fate of fertilzed ova are roughly comparable in man and other mammals.

Thirty-four fertilized human ova, good, bad and indifferent, recovered from 210 women of known fertility; a study of biologic wastage in early human pregnancy.

Arthur T. Hertig

Papers

Thirty-four fertilized human ova, good, bad and indifferent, recovered from 210 women of known fertility; a study of biologic wastage in early human pregnancy.

A series of potentially abortive ova recovered from fertile women prior to the first missed menstrual period.