Getting Pregnant After Miscarriage

After a miscarriage, it is easy to wonder, can I get pregnant again? What are my chances? What can I do to prevent another miscarriage? These can be difficult questions to ask and even more difficult to answer.

A miscarriage represents the sudden loss of a pregnancy prior to 20 weeks’ gestation. Many of the miscarriages happen because of a birth defect or serious genetic defect in the fetus. In fact, about half of all miscarriages are the result of a chromosomal abnormality in the fetus. On occasion, a health problem in the mother, such as a problem with her uterus or out of control diabetes in the first trimester can lead to a miscarriage prior to 20 weeks.

What are the chances of miscarrying again?

As most miscarriages are random genetic events, they usually are a onetime thing with no greater chance of having a miscarriage when compared to women who haven’t had a miscarriage. About 14 percent of all pregnancies will end in miscarriage if you have had no or just one miscarriage in the past. Only about 1 percent of women will have recurrent miscarriages (2 or more miscarriages).

If you have had two miscarriages in the past, your risk of another miscarriage is about 26 percent and, if you are unlucky enough to have had three miscarriages in the past, your miscarriage rate is about 28 percent in subsequent pregnancies.

Tests that might Help

If you have had 2 or more miscarriages in a row, talk to your doctor about whether or not you need further testing to find out if there is a medical reason why you are miscarrying, to see what your chances are of having another miscarriage. Doctors can do blood tests to see if you are making enough progesterone in the latter half of the cycle to support the pregnancy in its beginning stages.

You and the father of your baby may want to undergo genetic testing to make sure that you don’t carry a chromosomal abnormality that can lead to miscarriage. Sometimes the products of conception that are miscarried is tested for chromosomal abnormalities as well.

The doctor may also do the following to see if the uterus is normal:

• Hysteroscopy. This is when the doctor inserts a lighted camera at the end of a flexible tube through the uterus to see if there is anything wrong with the inside of the uterus. Biopsies can be taken if there are suspicious areas inside the uterus.
• Ultrasound. The ultrasound can tell if the uterus is of a normal size and shape using sound waves and a computer to visualize the inside of the uterus, the Fallopian tubes, and the ovaries, as well as any other thing in the pelvis that might contribute to miscarriages.
• Sonohysterogram. This is an ultrasound that is done after fluid is injected into the uterus through the cervix. It can tell what the inside of the uterus looks like and can detect abnormalities of the shape of the uterus.
• Hysterosalpingogram. This is a test where the doctor puts dye inside the uterus through a catheter inserted into the uterus. X-ray pictures are then taken which can help identify the inside of the uterus. It can also tell if the Fallopian tubes are open and normal.

When to get Pregnant after Miscarriage

Miscarriage is a loss that can cause depression and grief. You may want to get pregnant right away but you should give yourself a chance to grief your loss before trying to get pregnant again. You shouldn’t have sex within 2 weeks of a miscarriage so you don’t have a greater chance of having a uterine infection after your miscarriage. You will ovulate usually within 4 weeks of a miscarriage and can get pregnant as soon as then.

Many times, however, it is recommended to wait at least until you have had a normal period before attempting to get pregnant again. There is some evidence that you can have an increased miscarriage rate if you get pregnant right after having a miscarriage.

Improving the Chances of having a Normal Pregnancy

There is often nothing you can do to prevent miscarriages. Making healthy lifestyle choices before getting pregnant is the best thing you can do for yourself. This means eating healthy, cutting back on caffeine, exercising regularly, and avoiding things that can hurt a pregnancy, such as illegal drugs, smoking history, or alcohol use. Take a multivitamin with folic acid to increase the chances of conceiving a healthy baby.

Your doctor may want to watch you more closely if you get pregnant after more than one miscarriage. You may need progesterone supplementation in the latter part of your menstrual cycle so that you don’t lose this pregnancy as well. Talk to your doctor if you are trying to get pregnant after two or more prior miscarriages.

References:

• Love ER, et al. Effect of interpregnancy interval on outcomes of pregnancy after miscarriage: Retrospective analysis of hospital episode statistics in Scotland. British Medical Journal. 2010;341:C3967.