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By OBGYN Dr. Gleaton

No matter when a miscarriage happens, it can be devastating. More than a million American women report a miscarriage each year, and 80% of these happen in the first trimester. This month, Dr. Gleaton answered all your questions about pregnancy loss and miscarriage.

Would you consider two early miscarriages to be infertility? 

No, these are separate conditions. Two early miscarriages represent recurrent pregnancy loss however did not represent infertility. Infertility is defined as the inability to achieve pregnancy after trying for more than six months or one year dependent upon age.

What’s the best thing to do after recurrent miscarriages? Full work up or going to a fertility doctor?  

This depends on many factors including age, the number of prior miscarriages, and other risk factors.  If your OB/GYN initiates the workup this could be more cost effective than having these tests performed with some reproductive endocrinologists who may not bill insurance

Missed miscarriage and went the pill route. Any tips to help mind and body heal

It's common to experience a range of emotions following pregnancy loss. An important element of healing is to allow space for grief. Even with early miscarriages, such as a missed miscarriage, a bond has formed, and physical and emotional recovery takes time. Acknowledge this and commit to actively participating in your healing.

Consider counseling with a mental health professional, be selective of those around you, join a miscarriage support group, openly discuss your feelings with entrusted friends and family, and continue those healthy habits implemented when you first learned you were pregnant. 

How long (on average) for HCG to return to 0 after partial molar pregnancy? 

This is variable but we expect HCG to disappear by six months after a partial molar pregnancy.

How long after a MC should it take for my period to return?

Most people can expect their menstrual cycle to return four to six weeks after a pregnancy loss. Although it can occasionally take a little longer for cycles to regulate and return to their prior pattern.  

I keep having miscarriages. Dr. scheduled endometrial biopsy. Is that normal? 

Yes. The standard recurrent miscarriage work-up typically includes an ultrasound, lab work, and occasionally genetic testing of both you and your partner.  When common causes of miscarriage have been ruled out, an endometrial biopsy may offer useful information about the uterine lining and environment that may affect the process of implantation. Its most useful for ruling out polyps or infections of the uterine lining.

I’ve had 7 miscarriages over the course of 5 years, and one IUI. Is IVF the next best option?

Recurrent pregnancy loss and failed fertility treatments are so emotionally difficult. Yes, in most scenarios, IVF is the next step and will often yield a higher success rate because of the ability to test for embryos that are healthy, without chromosomal abnormalities. 

How common are miscarriages with IVF?

Although studies vary in the exact number, it is thought that 12-22% of pregnancies conceived via IVF will miscarry.

Read this article for specifics explaining factors affecting IVF success. 

I’m 12w3d. When can I feel “safer” about my risk of something going wrong? I had a previous miscarriage. 

Right about now! Thirteen weeks represents the end of the first trimester, so Congrats! Chances are much lower for pregnancy loss after the first trimester. 

I think my hormones are out of whack after miscarriage. Should I call PCP or OBGYN?

While some PCPs deal with hormonal imbalance, since it may be stemming from a recent miscarriage, most will redirect you to your OBGYN. If you’re missing cycles or feel out of sorts after a pregnancy loss, take a pregnancy test and notify your OBGYN of those results to determine if further workup is needed. 

What should I know about a balanced translocation while TTC? 

In a small number of couples who have repeated miscarriages, one partner has a chromosome in which a piece is transferred to another chromosome. This is called a translocation. People who have a translocation usually do not have any physical signs or symptoms, but some of their eggs or sperm will have abnormal chromosomes. If an embryo gets too much or too little genetic material, it often leads to a miscarriage. I would have a genetic discussion with your provider and likely a REI to discuss options to consider if recurrent miscarriage does occur. These options may include preimplantation genetic testing. This allows the selection of healthy embryos prior to implantation if needed.

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I’ve had two miscarriages this year. Should I be pushing for RPL testing before we try again? 

This is definitely a conversation worth having with your provider. Traditionally, RPL testing was reserved for 3+ miscarriages. However, ACOG currently recommends initiating testing after the second miscarriage.

Is it true women who went through a miscarriage are most fertile 1-2 cycles right after?

The honest answer: it's a bit unclear and data on this topic is confusing and conflicting. With that being said, there is some evidence from a study in 2003 and 2016 that suggests that women conceive at higher rates within the first 2 months after miscarriage. In clinical practice, I’ve not seen this as a consistent trend. 

Everyone keeps telling me I’m more likely to get pregnant after a miscarriage, any truth?

Again, data is not clear. We do know that if you’ve had one miscarriage, your pregnancy chances and chances for live birth are the same as the general population.

Just had my 2nd miscarriage after trying for 15 months… is it time to try IUI? 

I personally know how difficult recurrent pregnancy loss can be. However, now is the time to seek knowledge and devise a plan! Speak with you OB regarding initiating testing for recurrent pregnancy loss. This may include a transvaginal ultrasound, lab testing, and a thorough family and personal medical history.

I had a miscarriage at 8 weeks with D&C. How long until my uterine lining and hormones rebound? 

Typically, your body needs 6-8 weeks to recover from a hormonal standpoint. This is also the time frame wherein you’ll likely see your next menstrual cycle. 

TTC after miscarriage?

Trying to conceive after a pregnancy loss can be a time filled with mixed emotions, such as optimism, anxiety, hope, and fear. Some may be ready to TTC right away, while others may need more time to process the grief and disappointment associated with miscarriage.

Traditionally, providers have recommended a three month waiting period after miscarriage; however, this is not scientifically supported. While several studies have investigated the optimal timing of pregnancy after miscarriage, none have shown conclusive benefits from delaying conception.

If the miscarriage was before 13 weeks, it is typically safe to try to conceive with your next cycle after giving yourself a standard two week recovery. 

However, if a miscarriage occurs in the second trimester or is associated with other complications, a longer interval is sometimes recommended. When women experience a second trimester miscarriage (a miscarriage that occurs during weeks 14 to 28 of pregnancy), a longer interval between pregnancies is sometimes recommended. There are no conclusive studies demonstrating the exact interval in these cases. Always check with your OBGYN after miscarriage to discuss your plans to conceive and obtain specific recommendations.

Any tips for after a chemical pregnancy?

The silver lining to a chemical pregnancy is that it lets us know a person can get pregnant, even if that pregnancy was not completed. And for those patients where time is of the essence, there’s no medical reason why they can’t resume trying to get pregnant pretty quickly after a chemical pregnancy. In fact, a person can ovulate and get pregnant as soon as two weeks later. We also think that women may be more fertile following a chemical pregnancy based on some research. A recent study found that those who tried to get pregnant within 3 months of a loss were 18% more likely to conceive and 17% more likely to have a live birth than those who waited longer. The researchers did not find any increase in the risk of pregnancy complications in the group who immediately attempted conception.

What is the percentage of miscarriage after 12 weeks? 

More than 80% of pregnancies that miscarry do so within the first three months. Late miscarriages, (after 14 weeks) happen much less commonly at a rate of 2%. While early miscarriages are often related to genetic abnormalities, late pregnancy loss may occur due to broader issues that may include cervical insufficiency, growth issues, or birth defects. 

How common are back-to-back miscarriages?

Unfortunately, miscarriage is very common. One in four women experience pregnancy loss throughout their lifetime. That being said, if you are experiencing recurrent miscarriage (two or more clinical pregnancy losses), it is recommended that you see your OBGYN or fertility specialist.

I’ve heard that recurrent BV has correlation with early miscarriage.

Bacterial vaginosis (BV) represents a pH imbalance and is considered the most common Vaginal infection in women. It has been associated with an increase risk of pregnancy loss in both the first and second trimester. If you have a history of recurrent BV and are TTC or suffering from RPL, ask your provider for testing to rule out this common infection.

Difference between early miscarriage and chemical pregnancy?

A chemical pregnancy is a very early miscarriage that occurs when an egg is fertilized but does not fully implant into the uterus. Read Everything You Need to Know About Chemical Pregnancies

How to improve the chance of full term pregnancy after chemical pregnancy? 

Chemical pregnancies occur up to 33% of the time and are those occurring prior to the fifth week of pregnancy, before the fetus develops. They often aren’t clinically recognized because they occur near the same time as the expected menstrual cycle. 

After ruling out obvious causes with your OBGYN, focus on maintaining a healthy diet, adequate exercise and sleep, stress reduction, and taking a good prenatal. 

Will my cycle go right back to normal after a chemical pregnancy? 

Patients should expect their next menstrual cycle four to six weeks after a pregnancy loss. Although it can occasionally take a little longer for cycles to regulate and return to their prior pattern. 

Should I be worried about a second ectopic pregnancy with no risk factors? 

In general recurrent ectopic pregnancies occur in 10-27% of patients... and most patients with a prior ectopic will eventually have an intrauterine pregnancy. 

Started trying last October, miscarried, have been trying since and can’t get pregnant. Does that count as “try for a year,” or does the time restart after the miscarriage?

What an excellent question! The statistics suggest that 90% of couples will conceive within the first year of TTC, thus you achieved that. So, technically your year starts again. However, if waiting another year seems absolutely unbearable, why not split the difference.

You could visit your OBGYN provider after another six months of TTC, to check-in and see if additional testing is warranted at that point. Also please keep in mind that if you’re over 35, a fertility work-up is indicated after six months of TTC. 

 

Read more about miscarriage:

 

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