Ask the Experts: Pregnancy After Miscarriage

We got answers to common questions after experiencing a loss, plus advice on when it's the right time to try again.

When a pregnancy unexpectedly ends, it can be a confusing and emotional process for parents. While there’s no timeline for dealing with grief—and everyone copes with loss differently—understanding your options and what you can control may help with moving forward as your heart mends.

Amy Wetter, MD, OB-GYN at Northside Women’s Specialists in Atlanta, GA shines light on making sense of miscarriage and offers insight for partners desiring to conceive once more.

What Causes Miscarriage?

Between 10 and 20 percent of pregnancies end in a miscarriage. Many factors can lead to a loss, and it can be difficult to say with certainty what causes a particular miscarriage to occur. As an example, in one-third of early pregnancy loss occurring before eight weeks in the first trimester, there is a pregnancy sac but no embryo inside. This means that ovulation occurred, the egg was fertilized and the cells began to divide, but an embryo did not develop. In other cases, the embryo develops but it is abnormal. Chromosomal abnormalities, in particular, are common. One study found that of more than 8,000 miscarriages, 41 percent had chromosomal abnormalities.

In some cases, medical conditions in the mother, such as uncontrolled diabetes, or structural problems in the reproductive tract, such as uterine fibroids, can lead to miscarrying. Some studies have suggested that taking nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, very early in pregnancy leads to increased risk of miscarriage in pregnant women; however, there are conflicting data about this, and evidence is limited.

What Are the Odds of a Repeat Miscarriage?

Miscarriage is usually a one-time occurrence. Most women who miscarry a previous pregnancy go on to have healthy pregnancies after miscarriage. A small number of women—around 1 percent—will have recurrent miscarriages. The predicted risk of miscarriage in a future pregnancy remains about 20 percent after one miscarriage. After two consecutive miscarriages, the risk of another miscarriage increases to about 28 percent, and after three or more consecutive miscarriages, the risk is about 43 percent.

Does Repeated Pregnancy Loss Indicate a Bigger Problem, and What Can Be Done to Provide Clarity?

If you experience recurrent pregnancy loss two or more times in a row, your health care provider might recommend testing to identify any underlying causes before you attempt your next pregnancy. These tests include but are not limited to:

  • Blood tests. A sample of your blood is evaluated to help detect problems with hormones or your immune system.
  • Chromosomal tests. You and your partner might both have your blood tested to determine if your chromosomes are a factor. Tissue from the miscarriage—if it’s available—also might be tested.
  • Ultrasound. This imaging method uses high-frequency sound waves to produce precise images of structures within your body. Your women’s health provider places the ultrasound device over your abdomen or places it inside your vagina to obtain images of your uterus. An ultrasound might identify uterine problems, such as fibroids within the uterine cavity.
  • Hysteroscopy. Your doctor inserts a thin, lighted instrument called a hysteroscope through your cervix into your uterus to diagnose and treat identified intrauterine problems.
  • Hysterosalpingography. Your OB-GYN threads a thin tube through your vagina and cervix to release a liquid contrast dye into your uterus and fallopian tubes. The dye traces the shape of your uterine cavity and fallopian tubes and makes them visible on X-ray images. This procedure provides information about the internal contours of your uterus and any obstructions in the fallopian tubes.
  • Sono-hysterography. This ultrasound scan is done after saline is injected into the hollow part of your uterus through your vagina and cervix. This procedure provides information about the inside of your uterus, the outer surface of the uterus and any obstructions in the fallopian tubes.
  • Magnetic resonance imaging (MRI). This imaging test uses a magnetic field and radio waves to create detailed images of your uterus.

Is there a best time to conceive after a loss?

Typically, sex isn’t recommended for two weeks after a miscarriage to prevent an infection. You can ovulate and experience a new pregnancy as soon as two weeks after a miscarriage. Once you feel emotionally and physically ready to try again, ask your health care provider for guidance. After one miscarriage, there typically is no need to wait to conceive. After two or more miscarriages, your doctor might recommend testing.

What Can Mom Do to Improve Her Chances of a Successful Pregnancy and Healthy Baby?

Often, there is nothing you can do to prevent a miscarriage. However, making healthy lifestyle and wellness choices is important for you and your baby. Take a daily prenatal vitamin or folic acid supplement, ideally beginning a few months before conception. During pregnancy, limit caffeine and avoid drinking alcohol, smoking and using illicit drugs. Prior to pregnancy, discuss the need for any medication with your doctor and make sure you are taking only those medications that are necessary as well as discussing any recommended vaccinations. It is important to reach and maintain a healthy weight through healthy eating and regular physical activity.

What Spectrum of Emotions Can Someone Anticipate Through Miscarriage and Successful Conception Afterward?

Miscarriage can cause intense feelings of loss. You and your partner might also experience sadness, anxiety or guilt. Once you become pregnant again after miscarriage, you’ll likely feel joyful and excited as well as anxious. While becoming pregnant again can be a healing experience, anxiety and depression can continue even after the birth of a healthy child. Talk about your feelings and allow yourself to experience them fully. Turn to your partner, family and friends or a support group for comfort. If you’re having trouble coping, consult your health care provider or a counselor for extra support.

Lastly, remember there is no right or wrong way to feel. The loss of a pregnancy can cause significant grief. Sometimes these reactions are strong and long-lasting. You should let your provider know if you are feeling profound sadness or depression following pregnancy loss, especially if it continues for greater than several weeks. Referral for grief counseling or other treatment may be helpful.

Amy Wetter, MD, OB-GYN at Northside Women’s Specialists in Atlanta, GA

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