Pregnancy After Miscarriage

Expert: Amy Wetter, MD

When a pregnancy unexpectedly ends, processing the event is often emotional and possibly even confusing 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 after the loss of pregnancy may help you move forward as your heart mends.

If you’ve found yourself in this situation, you’ve probably had a lot of questions. In our Q&A with Amy Wetter, MD, an OB-GYN at Northside Women’s Specialists in Atlanta, Georgia, she shines a light on making sense of miscarriage and offers insight for partners desiring to conceive once more.

Q: What Causes Miscarriage?

A: Between 10-20% 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. For 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 of early miscarriage, the embryo develops, but it is abnormal. Chromosomal abnormalities, in particular, are common. One study found that of more than 8,000 miscarriages, 41% had chromosomal abnormalities.

In some cases, medical conditions in the birthing parent, such as uncontrolled diabetes, or structural problems in the reproductive tract, such as uterine fibroids, can lead to miscarrying. In others, there may be no physical reason that someone miscarries, but it can still happen.

Q: What Are the Odds of a Repeat Miscarriage?

A: Miscarriage is usually a one-time occurrence. Most who miscarry a previous pregnancy go on to have healthy pregnancies after miscarriage. A small number of birthing parents—around 2%—will have recurrent miscarriages. The predicted risk of miscarriage in a future pregnancy remains about 20% after one miscarriage. After two consecutive miscarriages, the risk of another miscarriage increases to about 28%, and after three or more consecutive miscarriages, the risk is about 43%.

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

A: 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 subsequent pregnancy. These tests include but are not limited to:

• Blood tests. A blood sample is evaluated to help detect hormonal or immunity problems.
• Chromosomal tests. You and your partner might 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 health care provider places the ultrasound device over your abdomen or inside the 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.

Q: Is There a Best Time To Conceive After a Loss?

A: 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.

Q: What Can a Birthing Parent Do to Improve Their Chances of a Viable Pregnancy?

A: Often, there are no obvious risk factors, so there is nothing you can do to prevent a miscarriage. However, healthy lifestyle and wellness choices are essential 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 drugs. Before becoming pregnant, discuss your prescription medications with your doctor to ensure you take only what’s necessary and considered safe during pregnancy. Also, discuss any recommended vaccinations.

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

A: Miscarriage can cause intense feelings of loss. You and your partner might also experience sadness, anxiety, or guilt. In a subsequent pregnancy after a miscarriage, you’ll likely feel joyful, excited, and anxious. While becoming pregnant again can be a healing experience, anxiety and depression can continue even after the birth of a child. Talk about your feelings and allow yourself to experience them fully. Turn to your partner, family, friends, a support group, or a mental health care provider. Lastly, remember there is no right or wrong way to feel. Pregnancy loss 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. A referral for grief counseling or other treatment may be beneficial.