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FAQ's

Having developed a rich, actionable repository based on our extensive experience, we have prepared a handy list of Frequently Asked Questions (FAQs) on key clinical procedures.

Why is physical examination done before deciding about surgery ?

Physical examination helps decide the patient’s fitness to undergo surgery. To begin with, information is collected on any past surgeries, smoking or drinking habits, history of jaundice during last six months, episodes of epileptic fits if any, cough, breathlessness on walking or climbing staircases or at night, excessive bleeding from cuts and wounds, allergy to certain drugs and sun. For woman patients, pregnancy details are also captured.

Why are patients advised to undergo blood and urine examination?

Pathological examination prior to surgery is conducted to:

• confirm clinical diagnosis through blood examination, and X-ray, if required.
• judge the patient’s ability and condition to withstand the stress induced due to surgery and / or anesthesia.

What are the different tests performed?

The types of tests required to confirm clinical diagnosis usually depend upon the type of the suspected illness. In case the operation directly involves vital organs such as the heart, kidney, and liver. specific and special tests are required to determine the conditions of these organs. In case of general operations, some common essentials tests are needed. The type of routine and essential tests depends on three factors: nature of the operation, and type of anesthesia required, patient’s age, and past and present illnesses if any.

If the patient does not have any accompanying health problem or symptoms, it is difficult to decide which laboratory tests are needed. The advantages of various tests, their utility, the cost involved, all these factors are considered. If the patient has had jaundice during six months prior to operation, a specific blood test- liver function test is necessary to know the condition of the liver function. The same is true for kidneys. In case the patient is suffering from high or low blood pressure, certain tests are done to understand the consequences during operation. If the person is obese, alcoholic, smoker or has any genetic disorders, certain tests become necessary.

Are all tests essential?

Although dozens of tests are available in medical science, only the essential ones have been given here. These have the maximum statistical possibility of elucidating adequate information in line with cost considerations. These tests are of a generalized nature and can sometimes vary according to the nature of surgery and patient’s condition.

What are the important points to note about any surgery?

No surgery should be taken lightly. However, there is certainly a qualitative difference between a major heart surgery, and a minor surgery to remove a corn. In surgical operations which do not exert much stress on the patient’s physiology (excision of corn or small superficial tumors, tooth extraction, cataract, vasectomy) it is enough to conduct blood and / or urine examination to detect diabetes and only the affected part of the body is rendered numb using ‘local anesthesia’. But this requires the patient’s co-operation.

Although some operations take only 10-15 minutes, they do not require general anesthesia (correction of simple fracture, curetting, and fissure). Minor surgeries like removal of tonsils, operation for hernia or cataract or curetting of the uterus do not exert any stress on the body’s physiology. Yet some laboratory investigations are necessary to assess the body’s capacity to cope with the stress due to anesthesia and to rule out a disease like diabetes which can cause complications in any surgery.

Anesthesia can exert a lot of stress on the body and therefore additional pathological examinations are needed such as determining the blood group, level of chemical substances in the blood, and whether the kidney function is affected.

Which operations are risky or difficult?

The risk during surgery depends upon the type and sensitivity of the illness and patient’s health. Major, emergency surgeries are risky. For e.g., operation for twisted or perforated intestines. However well-planned heart and brain operations can be comparatively safe. As a rule of thumb, surgery is done only when the probable operative risks are less than the probable risks of not doing that operation. (risk due to illness itself). However, one should always remember that any surgery has an element of unknown and unexpected risk.

What is Anesthesia?

‘Anesthesia’ means loss of sensation. But the term is commonly used to mean loss of consciousness. A surgery involves cutting or stretching of the tissues of the body, which cause pain. So, it is necessary to provide some form of pain relief. For very small surgeries like removal of sebaceous cyst, the surgeon can administer injection of local anesthetics at the site and make it numb. But for most of the other surgeries, pain relief involves use of specialized techniques and potent medicines, and it is the job of skilled postgraduate doctor in anesthesia.

What are the different types of Anesthesia?

General Anesthesia

In this type, the person is temporarily made unconscious so that no pain is perceived from the entire body. It is a carefully balanced combination of both inhaled and intravenously injected agents, which can be used for all operations.

Regional Anesthesia

This can only be used for surgery on selected regions of the body. An injection of local anesthetic medication adjacent to large groups of nerves temporarily prevents pain signals from reaching the brain. For example, for surgery of hip, prostate, or removal of uterus, spinal or epidural anesthesia can be used.

Monitored Anesthesia Care with Sedation:

This is also called as standby anesthesia. A local anesthesia is administered, and the anesthetist gives sedatives, pain killers, and other medications while also monitoring patient’s vital signs. Cataract surgery, for example, is frequently performed with this type of anesthesia. Before determining the most appropriate anesthetic plan, the anesthesiologist reviews patient’s medical condition, type and duration of operation and preferences.

Patients will meet and talk with the anesthesiologist during the pre-anesthesia checkup. This checkup can be few days before surgery if patient is admitted in hospital or on the day of patient’s admission. If patient has significant medical problems, bring these problems to the attention of surgeon well in advance.

Spinal / epidural Anesthesia

Of the variety of operations performed a major percentage involves operations below the waist. All these operation can be safely done under spinal or epidural anesthesia. The technique involves injection of local anesthetic medicine at appropriate site to block the nerves, as they exit the spinal cord. This prevents the pain sensation due to surgery from reaching the brain & relaxes the muscles of the area making it easy for the surgeon to operate.

Once in the operation theater the saline drip is started & blood pressure is measured. Other monitors are connected if necessary. The position for giving injection can be sitting or curled up on one side depending on the choice of anesthesiologist. The area of the injection is cleaned using antiseptic solution. The local anesthetic is injected at the appropriate location. Initially there is tingling and numbness which is gradually replaced by complete loss of sensation of lower limb & sometimes lower abdomen. Sedation is given to make the person comfortable unless the person wants to stay awake.

In epidural anesthesia, all the initial steps are similar except that the needle remains in a superficial plane. Through the needle a very fine catheter is passed into that plane & injections of local anesthetic are given through it. This way the anesthesia can be prolonged by giving the doses of medicines through the catheter for as is long as desired.

After the surgery is over, the sensations & the power in the lower limbs returns back to normal within few hours. The only side effect of these techniques is possibility of headache in an occasional patient. However, it is self-limiting & can be managed with pain killers. The remaining side effects are exceedingly rare. It has been conclusively proved that spinal or epidural does not cause long term backache.

The advantages of spinal or epidural over general anesthesia are
  • Overall risk is less
  • There is less blood loss during the surgery
  • For caesarean section, the baby is less likely to remain sleepy after birth
  • As less medicines are used, the chances of side effects & drug interaction are less.
Why are patients advised not to even consume water for eight to ten hours before operation?

Anesthesia tends to cause vomiting. On an empty stomach, chances of vomiting due to anesthesia are reduced. Vomiting, when unconscious, may obstruct breathing and cause bronchitis or pneumonia. Therefore, no solid or liquids including water should be consumed at least six hours before operation.

What happens on the day of operation?

Sometimes premedication injections are given a short while before the surgery to help the person to relax. A small plastic cannula is inserted in the vein to start saline drip. In the operation theatre blood pressure is checked and if necessary, monitors are connected. The anesthetist remains with the patient throughout the procedure, adjusting doses of drugs as needed.

What care should be taken just after surgery?

A patient is taken out of the operation theatre only after confirmation of the normal functioning of the heart and lungs.

  • Periodic examination of pulse and blood pressure is done depending upon the nature of surgery. The following are to be observed.
  • Patients having nausea should be made to sleep on the sides and not flat on the back to prevent vomit from entering the windpipe. At least the head should be positioned sideways. A tube is placed in the mouth to prevent the patient from swallowing his/her tongue. The tube should not be removed till the patient becomes conscious.
  • The patient does take time to fully recover from anesthesia. One should not panic if the patient groans in his/her sleep.
  • When a patient is given an intravenous saline drip, the hand or leg through which the injection needle is inserted is not allowed to be moved so as to prevent the dislodging of the needle and the consequent piercing of the vein.
  • After a major operation, when the patient recovers from anesthesia, he / she is advised to move legs. This should be complied with as such movements prevent the possible formation of clots in the blood vessels in the calf muscles.
  • A patient who is given general anesthesia for a longer duration is advised to take deep breaths periodically. This helps to circulate fresh air throughout the lungs which is necessary to reduce the risk of lung infections.
Why should nothing be given to the patient by mouth for some time after operation?

The reason is to avoid vomiting and related problems as explained earlier. However, if there is excessive dryness in the mouth, mere moistening of lips is helpful. In case of abdominal surgeries, this period of “fasting” extends a bit longer. This is because even mere handling or manipulation of intestines stops its usual involuntary contractile movements for some time. If it is a surgery of intestine, it takes still longer. Passing of gas or stools is taken as an indication of restoration of these intestinal movements

Why and how much of saline or glucose is given intravenously?

This is done to fulfil the patient’s daily requirement of water after the operation, when oral intake is not allowed for a variable period which is from a few hours to a few days, depending upon the surgery. Four to six bottles are required for an adult in a day. The amount of saline or fluids containing other salts, to be given depends upon the type of surgery and anesthesia, patient’s condition, frequency of vomiting and prevailing climatic condition.

What care should be taken to avoid stress on the stitches of the wound

Several misconceptions exist regarding stitches. The number of stitches is not important. What is important is the type of surgical problem and the organ operated upon. Secondly, normal limited movements do not snap the stitching. On the other hand, such movements help the healing process, reduces toughness and sourness of the wound and pain. It is not always necessary to stay in the hospital till the stitches are removed. When other bodily functions are restored and post-operative problems (such as bleeding) are not present, the patient can go home. It depends upon the type of surgery, patient’s health condition, other facilities and cleanliness at home, etc. It is advisable to take rest at home. An increased intake of lentils or “dal” is helpful. Unnecessary costly tonics do not hasten recovery or strength. It is wrong to think that some types of food items cause pus in the operation wound.

How long does it take for the wound to heal after an operation?

If there are no complications, the wound heals within 7-8 days. It takes almost six months for the damaged muscles to become perfectly normal. Although there is no danger in doing simple, limited, normal movements, lifting of weights and the like should be avoided for 4 weeks.

What is Curetting?

To scrape the inner most lining (endometrium) of uterus carefully is called curetting. A spoon-like instrument called ‘curette’ is used for this process, and so the word ‘curetting’. In layman’s terms, curetting is “to wash (clean) the uterus” but washing is a misnomer. Actually, there is no process of washing. Monthly menses is a normal process in woman’s life and there is nothing unhygienic about it, as lay people think. The wrong meaning of the word curetting must have evolved from this misconception.

Curetting is a minor operation in Obstetrics and Gynecology. If it is done carefully for the right purpose or indication, it is beneficial in many ways. At the same time, if it is done carelessly or unnecessarily, it may prove harmful.

Why is curetting done?

Curetting is done for diagnosing and treating some diseases of female genital tract.

For Diagnosis:

This operation is done for diagnosing the following diseases of female genital system:

  • Complaints about menses : (irregularity, heavy flow, early stoppage of menses, delayed periods). Curetting is done to diagnose the cause of irregularity of menses. If the scraped endometrium is viewed under microscope, then it is possible to comment on the effect of the hormones produced by ovaries on the endometrium.
  • While investigating for infertility, if sperms of the husband are normal, then we have to look for the maturity of the egg formed in ovary (ovulation). Until now, that was assessed by curetting only. But now a days we can know the maturity of the egg (graafian follicle) by measuring the levels of the hormone ‘Progesterone’ in the blood and also by sonography. Still curetting is done if above two tests are not available.
  • Just before menopause, some females complain of heavy flow. Whether that is because of hormonal imbalance or a warning of early cancer is exactly differentiated by curetting. Tuberculosis and cancer of uterus are diagnosed by curetting.

For Treatment:

Curetting is done as treatment of some diseases of uterus:

  • Curetting is done for diagnosing the cause of heavy flow. In about 30-40% of females this disease is cured. Though the scientific reason behind its cure is not known, curetting is done as it has proved to be beneficial.
  • While inserting the curette the mouth of the uterus needs to be temporarily dilated. In medical terms curetting is called Dilatation and Curettage i.e.: D & C. In certain situations, only the cervix needs to be dilated, e.g., when uterus is filled with pus or when radium rods need to be kept in uterus as a treatment of cancer.
  • It is also done to complete the incomplete abortion, by removing remaining products of conception from uterus.

Curetting done for ‘white discharge’ or for ‘pain in abdomen’ is wholly inappropriate and should be strictly avoided.

How is curetting done?

This operation can be done by anesthetizing (local anesthesia) only the cervix (mouth of uterus). But patient receives some pain in this procedure and full cooperation to the operating doctor, without any movement is not possible. For totally painless operation, General anesthesia is needed.

After giving Local or General Anesthesia, a rod called dilator is inserted through the cervix for dilatation. Then curette is inserted to scrape the endometrium. If it is done for diagnostic purpose, the scraped material is sent to the pathologist. The whole operation requires only 5-10 minutes.

This operation needs to be done 1-2 days before the menses in cases of menstrual irregularity, early stoppage of menses, infertility. It is done to know the effect of hormones produced by ovary on the endometrium. If done after 24 hours of commencement of menses, it is not useful as the endometrium is already shed off. It is important to carry out curetting as above-mentioned period for menstrual irregularity and infertility.

Is there any complication of the operation?

Led by the progress in anesthesiology and medical sciences, risks in this operation are markedly reduced. Still this operation has to be done by skilled doctor and with great care. If precautions before and after operation are followed, risk of complications is decreased.

Possible Complications during and after the operation:

  • Uterus may get infected and fallopian tubes which carry eggs may get blocked resulting in infertility.
  • In rare situations when endometrium is scrapped more than required or when curetting is done frequently, endometrium is fully destroyed resulting in Ashermann’s Syndrome. Consequently, menses totally stop, or they are scanty. This leads to infertility.
  • While dilating cervix, it may get injured. If done frequently, cervix may become loose and subsequent pregnancy may end up in abortion or preterm labour.
  • Repeated to and fro movements of curette during this operation may perforate the uterus and injure structures surrounding it. In that case, abdomen needs to be opened to treat the injuries.

    If the operation is done carefully, the rate of above-mentioned complications is decreased markedly but still life-threatening complication can occur in a very rare situation.

How does pregnancy happen?

A woman ovulates once a month between 10th to 14th day from the start of her last period if her cycle has 28-30 days length. The ovum travels down a fallopian tube and waits for 12 to 24 hrs. Sperms travel up past the cervix to travel through uterus to the fallopian tubes. There, it may combine with ovum to make an embryo. For conception this step is essential. The tiny embryo travels down into the uterus and attaches to the lining of the uterus. The embryo then grows and matures into a baby.

What is infertility? Is infertility a woman’s problem?

Infertility is usually defined as not being able to get pregnant despite trying for one year. A broader view of infertility includes not being able to carry a pregnancy to term and have a baby. Infertility affects about 10 percent of the reproductive age population. It is a myth that infertility is always a “woman’s problem.” About one third of infertility cases are due to male factor and one third are due to female factor. Other cases are due to a combination of male and female factors or to unknown causes.

What causes infertility in men?

Infertility in men is often caused by difficulties with quantity and quality of sperm or getting the sperm to reach the egg. Problems with sperm may exist from birth or develop later in life due to illness or injury. Some men produce no sperm or produce little sperm, and few have many abnormal sperms. Lifestyle can influence the number and quality of a man’s sperm. Alcohol, smoking and drugs can temporarily reduce sperm quality. Environmental toxins, including pesticides and lead, may cause some cases of infertility in men.

What causes infertility in women?

Defects with ovulation account for most infertilities in women. Without ovulation, eggs are not available to be fertilized. Signs of these with ovulation include irregular menstrual periods or no periods. Lifestyle factors including stress, diet, or athletic training can affect a woman’s hormonal balance. Much less often, a hormonal imbalance from a serious medical entity such as a pituitary gland tumor can cause ovulation problems. Regardless of the cause of these hormonal imbalances, the end result may be infertility.

Aging is an important factor in female infertility. The ability of a woman’s ovaries to produce eggs declines with age, especially after age 35. About one third of couples where the woman is over 35 will have problems with fertility. By the time she reaches menopause, when her monthly periods stop for good, a woman can no longer produce eggs or become pregnant on her own. Infertility of this sort may be treated through the use of donor eggs. Other factors can also lead to infertility in women. If the fallopian tubes are blocked at one or both ends, the egg can’t travel through the tubes into the uterus. Blocked tubes may result from pelvic inflammatory disease, endometriosis, or surgery for an ectopic pregnancy.

What are the essential tests done to investigate the likelihood of infertility?

If you are over 35, you should undergo a medical evaluation which begins with physical exams and medical and sexual histories of both partners. If there are no obvious problems, like improperly timed intercourse or absence of ovulation, tests may be needed to help determine the cause of the couple’s infertility.

For a man, this begins with tests of his semen to look at the number, shape, and movement of his sperm. Sometimes other kinds of tests, such as hormone tests, are done to help determine if the male is a contributing factor in the couple’s infertility.

For a woman, the first step in testing is to find out if she is ovulating each month. There are several ways to do this. For example, she can keep track of changes in her morning body temperature and in the texture of her cervical mucus. Another tool is a home ovulation test kit, which can be bought at drug or grocery stores.

Checks of ovulation can also be done in the doctor’s office, using blood tests for hormone levels or ultrasound tests of the ovaries. If the woman is ovulating, more tests will need to be done to determine her likely contribution to the couple’s infertility.

  • Hysterosalpingogram HSG : An examination of the fallopian tubes and uterus after they are injected with dye. It shows if the tubes are open and shows the shape of the uterus.
  • Laparoscopy : An exam of the tubes and other female organs for disease. An instrument called a laparoscope is used to see inside the abdomen.

What is the treatment for infertility?

Depending on the test results, different treatments can be suggested. 85 to 90 percent of infertility cases are treated with drugs or surgery. Various fertility drugs may be used for women with ovulation problems. It is important to talk with your health care provider about the drug to be used. You should understand the drug’s benefits and side effects. Depending on the type of fertility drug and the dosage of the drug used, multiple births (such as twins) can occur in some women. If needed, surgery can be done to repair damage to a woman’s ovaries, fallopian tubes, or uterus. Sometimes a man has an infertility problem that can be corrected by surgery.

What is the treatment for infertility?

Depending on the test results, different treatments can be suggested. 85 to 90 percent of infertility cases are treated with drugs or surgery. Various fertility drugs may be used for women with ovulation problems. It is important to talk with your health care provider about the drug to be used. You should understand the drug’s benefits and side effects. Depending on the type of fertility drug and the dosage of the drug used, multiple births (such as twins) can occur in some women. If needed, surgery can be done to repair damage to a woman’s ovaries, fallopian tubes, or uterus. Sometimes a man has an infertility problem that can be corrected by surgery.

What is assisted reproductive technology (ART)?

Assisted reproductive technology (ART) uses special methods to help infertile couples. ART involves handling both the woman’s eggs and the man’s sperm. Success rates vary and depend on many factors. ART can be expensive and time-consuming. But ART has made it possible for many couples to have children that otherwise would not have been conceived.

*In vitro fertilization (IVF) is a procedure made famous with the 1978 birth of Louise Brown, the world’s first “test tube baby.” IVF is often used when a woman’s fallopian tubes are blocked or when a man has low sperm counts. A drug is used to stimulate the ovaries to produce multiple eggs. Once mature, the eggs are removed and placed in a culture dish with the man’s sperm for fertilization. After about 40 hours, the eggs are examined to see if they have become fertilized by the sperm and are dividing into cells. These fertilized are then introduced inside the uterine cavity.

ART procedures sometimes involve the use of donor eggs (eggs from another woman) or previously frozen embryos. Donor eggs may be used if a woman has impaired ovaries or has a genetic disease that could be passed on to her baby.

What should the ideal uterine lining be at ovulation and at implantation

Ideally between 8 and 12 mm this should have a triple line pattern around the time of the LH surge and ovulation. The triple line occurs in response to estradiol; the HH/IE conversion is in response to progesterone.

How do we know if the sperm count is adequate for IUI?

Besides the number of sperms, the percentage with rapid forward-progressive motility and with normal morphology at the time of insemination are important to know. If the functional sperm count (number with normal morphology and rapid forward-progressive motility) exceeds 1 million; chances for pregnancy with well-timed IUI are excellent. See Semen Analysis fact sheet for more information.

What are leftover cysts in the ovaries? What causes these cysts? Do they go away?

A corpus luteum, or functional cyst, is simply a leftover follicle that has outstayed its welcome. Some continue to produce progesterone and estrogen, which may delay the arrival of the next period. Functional cysts almost always go away with time. Birth Control Pills are sometimes prescribed to hasten their resolution.

Why do cysts reduce chances of pregnancy?

Research has shown that any cyst 10 mm or larger is associated with a lower chance of getting pregnant. Cysts do not eliminate the possibility of pregnancy in a cycle, but they do reduce it. They do this through two mechanisms. First, physically, they can crowd out the development of new follicles. Also, if the cyst is secreting hormones at the wrong time of the cycle, (for example, progesterone during the follicular phase), it interferes with the chemical balance required for good quality ovulation and drastically reduces the chances of pregnancy.

What exactly is an endometrial biopsy?

In an endometrial biopsy (EMB), a small curette is threaded into the uterus and a sample is taken of the lining, or endometrium, during the last week of your cycle. Once the sample is obtained, it is rated according to the day of a 28- day cycle for which it would be typical. An out-of-phase endometrium means that the endometrial appearance is typical of a time in the cycle other than the time it was taken. This biopsy has the potential to disrupt a pregnancy in progress. An EMB may also be done to check for abnormal cells in the endometrium (hyperplasia). This is a concern when a woman has very infrequent periods or when ultrasound reveals a thick lining. For this purpose, the EMB can be done on any cycle day.

How long should one use tabs before moving to Injectables/IUI?

The vast majority of pregnancies occur during the first 4-5 ovulatory cycles. (if you do not stimulate well on tab at a reasonably high dosage, you might consider moving on to Injectable earlier. The maximum dosage is 150 mg., according to the manufacturer, and it may be wise to move on if unsuccessful after two cycles at that dosage). The average number of cycles on tabs before moving on is three to six.

What is the maximum recommended dosage for tab (clomiphene citrate)?

As mentioned above, the maximum dosage is 150 according to manufactures. It may be wise to move on if there is no response to 150 mg, as the risk of antiestrogenic side effects of Clomiphene citrate increase sharply as the dosage goes up.

How many times should anyone try IUI before moving on to IVF?

Once a patient has had 3-6 IUI cycles with injectable, they might consider moving to IVF as the chance of a successful IUI cycle is reduced.

How should IUIs be timed?

In most cases, doctors who do two IUIs do the first about 24 hours after the HCG shot and the second about 48 hours after the shot. Some studies have shown that doing one IUI about 36 hours after the HCG is equally effective. However, recent research suggests that higher pregnancy rates may be achieved by doing two IUIs, one at 12 hours past the HCG shot and one at 34 hours.

How are injectables administered?

Typically, they are taken daily for 7-12 days (although it is possible to take them as long as 14 days). If you are taking subcutaneous injections, they are administered in the stomach, upper arm or thigh, with a 1/2- or 5/8-inch needle. If they are intramuscular, they are given in the hip/buttocks area using a 1.5-inch needle. The partner usually administers the IM shots. You can also give the IM injection to yourself in the thigh. They feel like a flu shot or vaccine.

Should I use a BBT chart?

A Basal Body Temperature (BBT) chart is not a very reliable way to predict ovulation. Although the temperature shift associated with ovulation can be detected on a basal thermometer, it can sometimes take as long as two days before this shift shows up on a BBT. This generally means that by the time a temperature shift is detected, it is too late to time intercourse effectively. Further, there are many things that can negatively affect the reliability of BBT monitoring: A change in sleep patterns, answering nature’s call at night, catching a cold or flu and the like can change the results.
Do multiple cycles with fertility drugs increase the chance of getting ovarian cancer? Do your chances increase with each consecutive cycle?
No. There is no evidence that shows a statistically significant increase in the ovarian cancer risk. Each cycle is independent. The risk does not increase with each consecutive cycle.

How is egg quality ascertained?

You can get some idea of the egg quality from the size of the egg and the estradiol level at midcycle. But other factors arise as you get further into your 30s, such as whether the outside covering is too thick to be penetrated easily by the sperm. You really can’t diagnose egg quality until you get the eggs out of the follicles, put them under the microscope, and see how they behave. There are some less invasive screenings for ovarian reserve/egg quality such as the Clomiphene challenge, FSH, and Inhibin B, but they are also not as accurate as looking at the egg directly.

What causes chemical pregnancies?

Many early pregnancy failures are due to genetic abnormalities, mainly “trisomies” where an extra chromosome is present in what should ideally be a pair. Some pathologists believe that the earlier the failure occurs after implantation, the more likely it is to be genetic. You can also have implantation problems that would cause chemical pregnancies such as hyper coagulation, failure to form the needed blood vessels, or autoimmune issues. Note that chemical pregnancies are early miscarriages.