Pregnancy loss is all too common with up to 15% of pregnancies ending in miscarriage {pregnancy loss before 20 weeks}. It is a heartbreak I deal with on an almost daily basis with my patients. Some patients experience a later, heavier period crushing their baby hopes a few days after the excitement of the positive test. Other losses are much more gut wrenching. . .The first time mom showing up to her 20 week sonogram, entire family in tow, in hopes of finding out if they need to buy blue or pink sleepers, only to discover that their precious little one had passed a few weeks before without a signal. No matter the timing of the loss the two questions I most commonly hear are:
“Why did it happen?” and “When can I try again?”
In 75% of miscarriages before 20 weeks, the embryo had the bad luck of not forming properly from the start. When the sperm and egg came together, an extra piece of chromosome tagged along causing the baby’s genes to be abnormal. The most common types of abnormal chromosomes in miscarriages are turners syndrome {XO} and down syndrome {T21}. Other more rare causes can include thyroid abnormalities, smoking, Lupus, immune diseases or an abnormal shape of the uterus. In many cases, we never find out the true cause of the loss.
When a woman has had one first trimester loss, the problem is usually assumed to be abnormal fetal chromosomes, if no other obvious risk factors are noted. It is not recommended to perform an expensive workup; we simply recommend the patient try again. Which brings up the next question:
When is it OK to start trying again after a miscarriage?
Everyone reacts to pregnancy loss differently. Some women mourn deeply and need time to heal their hearts before they can even consider trying to conceive again. Others, while saddened, feel ready right away. I’ve had some patients who were not effected by miscarriage, but then feel guilty they weren’t sad. While we do have good data on how long to wait after a term delivery before TTC again, {approximately 18 months in a perfect world}, we did not have good studies to show when it was OK to try again after a miscarriage until recently. Previously, we recommended women to wait at least 3 cycles before TTC and even longer if they had a second trimester loss. This was based on extrapolated data from term deliveries. A new study has provided reassurance for those women who are ready to try again quickly: it is actually OK to try again right away.
Scliep et al reported in this month’s Obstetrics and Gynecology that patients who started trying to conceive immediately after a miscarriage had improved rates of conception and lower rates of miscarriage than those who waited 3-6 months to start trying again. This is not to encourage you to try before you are ready emotionally, but when you do feel ready there is no need to wait. We had previously told women their rates of repeat miscarriage were possibly higher if they conceived within the first few months of a loss, we now know that is not the case.
If you came across this post after recently experiencing a loss, I’m so very sorry for your heartbreak. As with all medical decisions, please talk with your provider about your specific risk factors, but know that for the average woman it is perfectly fine to start trying to conceive again as soon as your heart is ready.
Have you experienced pregnancy after loss? How long did you wait until you tried to conceive again?
I have experienced 3 first trimester miscarriages in a row now, my last in january. It has been the most heartbreaking experience. The last one they did a D&C and figured out I lost it due to Trisomy 8. They’re doing more testing to double check that there are no other factors but they’re telling me it was likely I just had really bad luck, three times. It’s really hard for me after having a loss 3/3 times to think about trying again. My husband and I want a baby so badly but I’m not sure I can handle another loss. Even though they say my chances of having a successful pregnancy are as good as anyone else’s, it hard to believe when I’ve already had “bad Luck” 3 times.
I soooo feel for you, as I experienced two first trimester losses myself. I want to share a website that a friend of a friend created. I hope you can find comfort, hope, and the knowledge that you are lot alone. Lots of love and prayers to you!
http://www.alittlerayofsunshine.today/
Thank you. I appreciate it.