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1.  You are wise to the fact that pregnancy does not necessarily = baby.

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So you are pregnant! Exciting, isn’t it? But…Yes, there’s a “but” in there. You have also recently experienced a miscarriage and the heart wrenching sobbing after an appointment where someone in an official uniform told you, “I’m so sorry. We couldn’t find a heart beat.”

You should feel lucky to be pregnant again so soon. Shouldn’t you? But your heart was so recently ripped in two and all you can bring yourself to feel is anxious and worried. There’s just no room for happy here. Well, maybe for the slightest little sliver of happy, but it’s just not the same.

Here are some things that can be hard about being pregnant after a miscarriage.

You become pregnant for the first time and what happens? Well, you immediately have a mental picture of that child all the way from birth through college. Never once do you imagine that miscarriage can happen to you. So you plan, and dream and begin to love that wee little baby in your belly and then…”There is no heartbeat” and your world comes crashing down around you. All the plans that you had, all of the dreams that you dreamed are gone. In an instant. And you realize then that being pregnant doesn’t always promise you your baby.

So when you become pregnant again, do you dare to hope and dream once more? It just hurt so much last time to lose those dreams. Well, you do hope and dream a little. But much more tentatively. You can never let loose with the joy of abandon like the last time. That kind of joy during pregnancy is sadly gone for you.

2. Most people don’t know about your miscarriage(s).

So unfortunately we seem to treat miscarriage like a dirty little secret. Everyone tells you not to share your pregnancy news until after three months so that you don’t have to “untell” anyone if something goes wrong. Well, I fell into this trap too. I kept these little babies a secret from all but a few people. It’s hard because then no one understands why you are a little tentative during your new pregnancy. Nobody understands why you get sad sometimes without warning or why you don’t talk that much about the baby you are pregnant with in future terms.

3. You are far too attuned to your body’s twinges.

Every little pain, every little twinge, your first thought is always that you’re losing the baby. No matter how much your doctor reassures you, no matter how many prenatal nurses tell you that it’s a normal feeling, you worry. And heaven forbid that you spot at all during the 9 months. It doesn’t necessarily mean miscarriage, but it sure as heck feels like it.

4. You feel guilty.

Even though there is no reason to feel this way, you still wonder: is there something that I did wrong last time? Is there something I can do differently this time? You even feel guilty for not being as happy as you should be. Some people have such a hard time even getting pregnant at all and you know that you are blessed to have gotten pregnant so easily again. You know in your head that you are lucky to have conceived, but your heart is too scared to feel happy just yet. So there are a lot of conflicting feelings when you are pregnant after a miscarriage.

5. You can only truly breathe properly after an ultrasound.

Seeing is believing. When I saw that my baby was okay, then I could trust that they were okay…for a bit anyways. The nerves leading up to each scan were so heavy. When you’ve heard “I’m sorry, there is no heartbeat” before, then it’s hard to allow yourself to believe that this time will have a happy ending.

6. Even when the baby is born, you don’t believe they are truly here and okay until they are placed in your arms.

After my daughter was born, there was silence. No crying….just nothing. I was sure that something had gone horribly wrong because in all the tv shows they cry immediately, right? I think if I had never experienced loss I might not have become so panicked. But I had, so I did. Thank goodness she was okay and when they put her in my arms, I was able to see that she was alive, beautifully healthy and perfect.

So it can be hard to be pregnant when you can’t allow yourself to feel the unbridled joy you felt the first time. That certainty that everything will be okay and that you can make plans for the future is not part of this new pregnancy. Please know if you’ve felt this way that you are not alone. There are others who share that pain, like me.

But thankfully, as soon as my daughter was placed in my arms, I got to experience all those feelings that I had missed out on during the pregnancy. The happiness, the joy, and the plans for the future, from newborn to college. Those feelings I had been denied this time around came rushing in all at once when I saw her face and I realized then and there that a rainbow is a beautiful thing. Such an amazing, beautiful thing.

Signed,

Mother of 3 angel babies and 2 rainbow girls

All About Pregnancy After Miscarriage

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For women who have experienced a miscarriage, there’s no “one size fits all” solution to managing grief. While some start trying to conceive again right away, others take months or years to overcome their emotional burden.

But take heart—it’s very likely you will come out the other side with the baby you’ve dreamed of. “If you’ve had one miscarriage, your chance of having a successful pregnancy isn’t any different from anybody else’s,” says Jani Jensen, M.D., a reproductive endocrinologist and assistant professor at the Mayo Clinic in Rochester, Minnesota. “That should be hopeful news for couples.” Once you’re able to create an embryo, odds are that you’ll carry another one to term in the future.

  • RELATED: What Causes Miscarriage to Happen?

So how soon after a miscarriage can you get pregnant, and is there an ideal time to begin having baby-making sex? We spoke with experts to find out.

Having Sex After Miscarriage

After a miscarriage, your body will likely complete the process on its own; otherwise, you’ll need a dilation and curettage (D&C) to surgically remove the contents of the uterus. So how long after a miscarriage can you have sex?

Angela Chaudhari, M.D., a gynecologic surgeon and assistant professor in the Department of Obstetrics and Gynecology at Northwestern University Feinberg School of Medicine in Chicago, Illinois, recommends visiting your OB-GYN for follow-up appointment about two weeks after the miscarriage. If everything looks fine, “I tell my patients to go ahead and have intercourse,” says Dr. Chaudhari. She notes, however, that women who had a D&C might need to wait a few weeks to control the bleeding.

  • RELATED: How to Prevent Miscarriage: Is There Anything You Can Do?

How Soon After a Miscarriage Can You Get Pregnant?

While it’s safe to have sex soon after miscarriage, women should consider waiting two months to conceive again, explains Dr. Zev Williams, M.D., Ph.D., director of the Program for Early and Recurrent Pregnancy Loss (PEARL) at Montefiore Medical Center and Albert Einstein College of Medicine in New York. However, Dr. Williams goes on to say, “it is most likely safe to try to conceive following one full menstrual cycle after the miscarriage.”

Women may ovulate as soon as two weeks after a miscarriage, assuming the baby was lost before 13 weeks, but it generally takes a full two months for her to cycle return. Waiting for a full two months—or for a complete and normal menstrual cycle, which generally takes about two months—ensures that the pregnancy hormone hCG has dipped to levels so low that it’s undetectable. The uterine lining will also return to normal, making it receptive to receive a future fertilized embryo.

With trying for a pregnancy following a miscarriage, the goal, explains Dr. Williams, is to “reset” the body by allowing a full menstrual cycle to occur. If a woman attempts pregnancy right away, before the pregnancy hormones from the miscarriage have cleared from her body, she may receive a false positive on a pregnancy test. Conversely, her doctor may mistakenly pick up falling pregnancy hormone levels from the miscarriage and deduce that she is miscarrying the second pregnancy.

  • RELATED: Signs of Miscarriage: When Should I Worry?

Unfortunately, the only way to know for sure if the pregnancy hormones have completely decreased down to “zero” is to receive a blood test. Although Dr. Williams admits that it may not be the standard of care in all offices, he encourages women to ask their doctors for the blood test after miscarriage, especially if they are hoping to try for another pregnancy as soon as possible. In general, he recommends waiting about six weeks in the case of a first trimester miscarriage for the test.

Note that the further along in the pregnancy a woman is, the higher her pregnancy hormones will be, so you might need to wait longer for second trimester miscarriages. “It’s important to make sure that your hormone levels and the uterine lining have returned to normal,” explains Dr. Williams. “And that can take longer when a pregnancy has been farther along.”

How to Conceive After Miscarriage

The trick to conceiving after miscarriage is no different than it was initially. “You need to try to time intercourse as close to ovulation as possible and have sex every other day in the days leading up to it as well,” says Dr. Chaudhari.

  • RELATED: Your Risk of Miscarriage at Different Points of Pregnancy

In addition to general recommendations for pregnancy planning—such as maintaining a nutritious diet and starting on prenatal vitamins—mothers-to-be should “check in” on their emotional well-being. “You don’t want to get pregnant simply to replace that pregnancy,” explains Alice Domar, PhD, executive director of the Domar Center for Mind/Body Health at Boston IVF, assistant professor of Obstetrics, Gynecology, and Reproductive Biology at Harvard Medical School, and author of Conquering Infertility. “Start trying when you feel truly ready for the outcome, whether it’s not getting pregnant, getting pregnant and having another loss, or getting pregnant and having a baby.”

The most important thing: always ask your doctor when you should try to conceive again. Every miscarriage is different, and your doctor can advise you on personal health.

Is It Easier to Get Pregnant After a Miscarriage?

It’s unclear whether fertility increases after a miscarriage. However, a 2016 study from the National Institute of Health, published in the journal Obstetrics & Gynecology, studied more than 1,000 women, and it found that 70% conceived within three months of miscarriage. Compare this with the 51% of women who conceived after waiting longer. More information is needed, but the study may show that there’s no need to wait for conception after miscarriage.

  • RELATED: What You Need to Know About Recurrent Miscarriages

Will I Miscarry Again?

According to Dr. Chaudhari, “there was some old data that perhaps people are more likely to miscarry again if they try immediately after, but that’s all been debunked.” In reality, the odds of a successful, healthy pregnancy after miscarriage are definitely in your favor. According to the American Pregnancy Association (APA), at least 85 percent of women who have suffered a miscarriage will go on to have a healthy, full-term pregnancy afterward.

The Emotional Impact of Pregnancy After Miscarriage

Of course, getting the green light for sex after miscarriage physically doesn’t mean you’re actually up for it mentally. Many doctors feel that a woman’s emotional and mental health is as vitally important her physical health. “Attitude, positive thinking, receiving the correct information about her previous miscarriage, knowing her possibilities, considering that more than 85 percent of women get pregnant after a miscarriage, but at the same time, knowing her risks,” are all part of the package, explains Dr. Ricardo Huete, Chief of OB-GYN at Torrance Memorial Medical Center in California.

  • RELATED: Can You Have Postpartum Depression After a Miscarriage?

What’s more, this whirlwind of emotions won’t disappear when you successfully get pregnant after a miscarriage. Indeed, if your last pregnancy ended in a loss, you may find yourself feeling overwhelmed with anxiety at every single milestone you reach during your new pregnancy. It’s also natural to rein in your excitement about having another baby after you’ve suffered a loss. You might do this in order to protect yourself, hoping to lessen your grief if you miscarry again.

Try leaning on family, friends, and health-care providers for extra support—and realize that your partner might need additional attention too. And remember: the odds are in your favor that your next pregnancy will go smoothly!

  • By Holly Eagleson, Adrienne Lieberman, and Chaunie Marie Brusie, RN, BSN

Baby Care

Likely to get pregnant sooner

Exactly how long a woman should wait to conceive after a miscarriage remains controversial. However, recent research opines that women who try conception within 3 months post miscarriage are more likely to be successful than others. A woman who did not experience ectopic pregnancy should try again as soon as possible. Some doctors recommend 18 months wait for ectopic pregnancy related miscarriages.

Conceiving quickly may keep at bay the paralysis of fear after traumatic loss

Conception after a miscarriage may bring up a whole host of emotions from joy and happiness to a fresh wave of grief for the loss. Many women who have had miscarriages will feel extra vigilant and nervous. Conceiving quickly is likely to suppress the emotions and although the mix of emotions and hormones are normal, victims should be open with their feelings to their partners and health care providers.

No danger in trying

ALSO READ: Six earliest pregnancy symptoms

Attempting to get pregnant right after a miscarriage doesn’t seem to predispose a mom to any known increased risks as long as her prior miscarriage is complete and no reasons specific to a condition that warrants waiting identified. For years, we have been told that waiting was the best way to ensure a good outcome for all without anyone really explaining why. The female body is sufficient as it continues to release eggs and can carry a child again very quickly.

Advanced age

Advanced maternal age is when a woman is 35 years or older and pregnant. These women are at increased risk of fertility issues, pre-term labor and needing a C-section. They are likely to have a child with Down’s syndrome or become pregnant with multiples which is a high risk for them.

Fertility mode

In Early miscarriages where women were actively trying to conceive, they are likely to be still habituated to safe conception guidelines followed previously.

When a woman decides to conceive shortly after miscarriage she is unlikely to start behaviors that put her and the baby at risk. Overtime, women may start getting relaxed and take up risky behaviors again either for pleasure or as coping devices to deal with loss, this can make it harder for her to get pregnant or increase her risk of having another miscarriage.

Paternal age

ALSO READ: What are the chances of having twins?

Unlike women who are born with a set of amount of eggs that will one day stop flowing, men are generally considered sperm making machines. Trying again after miscarriage is a good idea if dad’s age is a factor because men who have children when they are older may put them to risk of autism and cancer with the added stress of coming to the world at a low birth weight.

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My period finally arrived four days late (likely because my hormones still were not back to normal after my miscarriage), and it was almost a relief. Finally, I had a clear sign that I wasn’t pregnant, a definitive clue to stop me from obsessing. Still, it was apparent to me that I had to change the way I was approaching the pregnancy journey this time around.

Apparently, I’m not the only one who feels overwhelmed and anxious over trying to conceive again after a miscarriage.

“It’s incredibly common after a loss to become completely consumed with getting pregnant again,” Tamar Gur, M.D., a women’s health expert and reproductive psychiatrist at The Ohio State University Wexner Medical Center, tells SELF. Even people without a history of anxiety or depression can fall into an obsessive mind-set, she says.

The way people approach trying to conceive after a miscarriage usually depends on how they reacted to the miscarriage in the first place, Catherine Birndorf, M.D., founder of The Motherhood Center in New York City, tells SELF. For some, the experience is upsetting; for others, it’s a full-blown trauma. “Depending on how the experience was for you, you may be more or less primed to feel anxious,” Dr. Birndorf says.

To be honest, there are also times where I’ve felt waves of guilt over my desire to be pregnant again so soon after my loss. But at some point, I had to accept the fact that nothing I said or did would make those babies come back, even though I wanted that pregnancy to work out.

Apparently, feelings like this are also normal, Dr. Gur assured me, while reminding me that one pregnancy doesn’t necessarily have to do with another. “ is not necessarily to replace that child you lost, but to fulfill that dream,” she explains.

If you’re healthy, there’s no right or wrong time to start trying to have a baby again after a miscarriage. It’s up to you and whether you feel emotionally ready.

“If you have a miscarriage that does not require any surgical intervention, it is generally recommended that you wait until after one normal period before trying to conceive again,” board-certified ob/gyn Shannon M. Clark, M.D., an associate professor of maternal-fetal medicine at the University of Texas Medical Branch and founder of BabiesAfter35.com, tells SELF. Waiting until you have a period makes calculating the due date of your next pregnancy easier, she explains. But it is possible to get pregnant before your period returns.

If you don’t want to wait to have a normal period, it’s at least recommended that you wait two weeks to allow your cervix to close again to decrease the risk of infection, Dr. Clark says.

But, if your miscarriage involved a surgical intervention, like a D&C or D&E, your doctor will likely ask you to wait a few cycles to allow your cervix to close and your uterine lining to heal, Dr. Clark says. “You should have a conversation with your obstetrical care provider who knows you and your history regarding the recommended time to wait,” she explains.

Given that I had a D&E, my doctor recommended we wait two cycles to allow my body to heal. So, it may have actually been a blessing in disguise that things didn’t work out this month.

It’s not easy to stay calm and collected while trying to conceive again, but I’ve taken a few steps to help keep a level head through the process.

While navigating this unique situation, it’s important to identify which behaviors are helpful and which are only adding stress, Dr. Birndorf says—and everyone is different. Personally, I’ve vowed to not take pregnancy tests until my period is at least a day late and to stop using ovulation predictor kits for anything other than their intended use. (Dr. Clark says the whole concept of using an ovulation predictor kit to detect an early pregnancy is unproven anyway.)

Conceiving After Miscarriage: How Long Should You Wait?

For those who lose a pregnancy in the first or second trimester, the question of when to begin trying to conceive again can often be fraught with emotion and uncertainty. Conventional wisdom has led doctors to recommend that women wait at least three months after a miscarriage before trying to get pregnant again with the belief that this delay will reduce the risk of another miscarriage. But conventional wisdom is not always based on evidence, and a new study suggests that the three-month wait recommendation isn’t warranted if the concern is another loss.

“Although our study supports the hypothesis that there is no physiologic reason for delaying pregnancy attempt after a loss, whether a couple needs time to heal emotionally after a loss may be dependent on many factors,” wrote the research team from the National Institute of Child Health and Human Development in Bethesda, Maryland. “Although emotional compared with physical readiness may require individual couple assessment, previous research has found that a speedy new pregnancy and birth of a living child lessens grief among couples who are suffering from a pregnancy loss.”

That possible outcome, however, is one of several possible ones; another outcome could be another miscarriage, which happened to Renea L., a 34-year-old from Chicago. Although her first pregnancy was a surprise, the miscarriage at 12 weeks devastated her, she said.

“I was an absolute mess after our first loss,” Renea said. As many do, her doctor recommending waiting at least three cycles before trying to conceive again to ensure her body was back to its pre-pregnant state, but she and her partner had decided to wait to try again until she was finished with nursing school.

“Even being cautious, we ended up conceiving again close to a year after our loss,” she said. She also lost that pregnancy, this time at 8 weeks, and was so devastated she wasn’t sure she wanted to try to conceive again. A year later, however, they tried again, became pregnant after two cycles and carried their healthy now-19-month-old to term.

If she had it to do over, “I would still wait at least the three cycles,” she said. “I think I would need to mentally, if not physically.”

Indeed, this study’s findings suggest there is no physical reason, but psychological reasons cannot be discounted. In the study, the researchers tracked 1,083 women with two previous miscarriages for up to six menstrual cycles while they tried to conceive and then through delivery if the women became pregnant. None of the women’s most recent pregnancies had resulted in a live birth or stillbirth or had involved an ectopic or molar pregnancy, and 99% of the women had lost their fetus at 19 weeks of pregnancy or earlier.

Nearly a quarter of the women (23%) waited more than three months after their last pregnancy loss before attempting to conceive again, but the other 77% began trying to conceive within three months after their loss. Among those who began trying to conceive within three months, just over half (53%) became pregnant and gave birth to a live baby. Meanwhile just over a third (36%) of those who waited at least three months after their loss before trying to conceive. In general, those who began trying earlier also became pregnant more quickly once they started trying compared to those who waited longer before starting to try again.

Although the study found no physiological reason not to starting trying to conceive right after a… pregnancy loss, couples may need more time to psychologically heal before they’re ready to try again. Photo by tiger_jnr

The researchers made adjustments in their calculations to account for differences among the women in terms of their age, their partner’s age, body mass index, race, education, income, smoking history, alcohol use, physical activity, marital status, subfertility (history of difficulty conceiving over at least a year of trying), previous children, previous losses, gestational age of previous loss and use of a dilation and curettage (D&C) for the previous loss or not. After these adjustments, women who started trying to conceive within three months after their last miscarriage still had approximately 65% greater odds of becoming pregnant and giving live birth than women who waited.

“Our results indicate that there is no physiologic basis for delaying pregnancy attempt after a non- ectopic, nonmolar, less than 20-week gestational age pregnancy loss,” the authors wrote.

Yet, “traditions are hard to change, and many clinicians continue to advise waiting at least three months for this reason despite numerous studies showing no relationship between attempts at conception within three months of a previous loss and repeat early pregnancy loss,” wrote William Hurd, MD, in a commentary that accompanied the study. “However, the recommendation to delay subsequent conception for three months is not without merit,” he continued. “A number of studies have found that a short interval between any pregnancy (including spontaneous or induced abortions) and a subsequent pregnancy is associated with increased risk of pregnancy complications, including preeclampsia, premature rupture of membranes, low birth weight and preterm delivery.”

Increased risk of those outcomes was not seen in this study, and the authors clarify that waiting at least two years after a live birth to try to conceive again is reasonable based on available evidence. A bigger question this study brings up is whether it’s actually better to start trying to conceive very soon after a miscarriage. Not necessarily, Hurd implies.

Hurd points out that selection bias could play a role in this study’s findings because the patients who began attempting to conceive within three months of their miscarriage, as a group, “were more likely to be longer and have a lower body mass index and less likely to have a history of sub fertility”—all of which are linked to being able to get pregnant more quickly or easily.

These differences between the groups are small, however. The group who began trying to conceive within three months had an average age of 28.6 years, an average BMI of 26 and a partner with an average age of 29.8, compared to an average age of 29.4, an average BMI of 27.2 and an average partner age of 31 among those who waited at least three months. While only 6.6% of the women who began trying to conceive within three months had a history of subfertility, the rate was 10.3% in the group who waited longer. These differences were accounted for, but it’s not possible to completely erase every possible difference between the groups mathematically. He also notes that recall bias—participants’ misremembering—could influence the results. Although the study found no physiological reason to wait three months, Hurd said there may be psychological reasons to wait.

“The authors remind us that many patients need time to heal emotionally after a loss,” he writes. “Although they also mention that a new pregnancy resulting in the birth of a child lessens grief, they do not comment on the detrimental effects a subsequent early pregnancy loss can have on couples who are not adequately emotionally healed.”

That’s exactly what might lead Stephanie Burnett, a 25-year-old in Oklahoma, and her husband to consider adopting their next child if they choose to have another. After two early first-trimester miscarriages—before she had seen a doctor—her physician told her that her endometriosis made it unlikely she would be able to have children. Still, she became pregnant a third time—which ended in miscarriage in January 2013. Her doctor cleared her six weeks later for trying to conceive again. Exactly four months later, she had conceived again, and she carried her now-healthy son to term. Since then, however, she has had another miscarriage and likely will wait several years before trying to conceive again if only because she’s not sure she can go through another miscarriage again.

“In light of the 15-20% sporadic early pregnancy loss rate, it makes sense to verify after a loss that couples are emotionally prepared to cope with another loss before attempting pregnancy,” Hurd writes. “Clearly, some traditions that have stood the test of time are based on sound reasoning.”

My book, The Informed Parent, with co-author Emily Willingham, is available for pre-order. Find me on Twitter here.

What The Science Really Says About Pregnancy After a Miscarriage

Getting pregnant can be difficult. The same goes for staying pregnant, considering the fact that nearly 25 percent of pregnancies end in miscarriage. Enduring a loss of pregnancy is often painful, but as much as healing takes time, men and women may not want to wait too long before they try again. Contrary to commonly-held beliefs and even many official recommendations, research shows that couples who try to conceive within three months of a miscarriage may be more likely to become pregnant and have a healthy pregnancy than those who wait longer.

The National Institute of Health has found that patients who conceived within three months following a miscarriage had a higher live birth rate than those who waited longer — 53 percent compared to 36 percent. Additional research from the NIH found that women who got pregnant again within three months of a miscarriage reduced their risk of another pregnancy loss compared to women who conceived after three months.

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“If a woman decides to wait to attempt conception, the miscarriage risk is slightly higher,” says Dr. Mark Trolice, an OB/GYN and reproductive endocrinologist.

This thinking goes against recommendations from very big organizations. The World Health Organization, for one, recommends couples wait up to six months before trying again. The reasoning here is mostly for psychological. It is fair to say that extreme emotional distress is not healthy for pregnant women or their developing babies. Bereavement during pregnancy has been linked with an increased risk of stillbirth and depression during pregnancy is associated with a greater risk of sleep and mental health problems for their children later in life. But it is also fair to say that extreme emotional distress does not accurately characterize every person’s experience with miscarriage. Trolice puts it more bluntly: “This recommendation was not based on solid medical evidence.”.

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Exactly why trying within a three-month window is advantageous is not settled science. Trolice suspects that couples who conceive right away might be more likely to make the health and lifestyle adjustments needed for a healthy pregnancy. For instance, women who waited longer to conceive had higher rates of obesity compared to women who tried to get pregnant right away.

Another possibility: Women who tried to get pregnant within three months may have had more luck, for the simple and unflattering fact that prospective parents are not getting any younger. As more and more couples opt to have children later in life, advancing maternal age has put many women at an increased risk of miscarriage, and advancing paternal age comes with risks for the fetus well. Given men’s and women’s ticking biological clocks, it makes sense that waiting to try after a miscarriage.

“A woman’s peak fertility is actually in her mid-to-late twenties and begins to decline more rapidly after the age of 35,” Dr. Tom Molinaro, a reproductive endocrinologist at the Reproductive Medicine Associates of New Jersey, says. “Because of this, a couple should begin trying to conceive as soon as they are ready.”

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Every pregnancy is different and so is every miscarriage, so there are many limitations to consider with this data. If the miscarriage involved any medical procedure it is crucial to take advice from a doctor about when to hold off in order to avoid complications and infections. Couples who have had recurrent miscarriages or experienced a miscarriage after 13 weeks (most miscarriages occur before), there are caveats about trying sooner than later that could pose a health threat to women and their babies, and it is important to discuss these with medical professionals.

Both Molinaro and Trolice agree that there is no one-size-fits-all prescription for men and women trying to conceive after a miscarriage. However, if couples are physically and psychologically ready to get back on the baby-making horse, there is no need to wait six months to start trying. On the other hand, there is no need to minimize the loss or rush the grief process either.

“The impact of miscarriage on the couple is often akin to a death in the family. A grieving process is important to ensure full emotional recovery,” Trolice says. “If the couple feels they have healed emotionally and the woman has recovered physically, then they can attempt conception within three months following a pregnancy loss — with reassuring evidence of no increase in miscarriage and probably a higher live birth rate.”

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After a Miscarriage: Getting Pregnant Again

You may want to consider seeking help if you:

  • Have had two or more miscarriages
  • Are over age 35
  • Have an illness that may affect your pregnancy (such as diabetes)
  • Have experienced fertility issues

How do we decide when to try again?

Deciding when to try again is a decision only you as a couple can make. Another pregnancy won’t replace the lost pregnancy but may help you by refocusing your attention. If there were medical complications with your miscarriage, make sure to discuss the plans to try again with your health care provider first.

How might we feel during the next pregnancy?

Your next pregnancy might not be as joyful as you would like because you’ve learned that life doesn’t always go according to your plans. You can’t say it’s your first, but it is also difficult to say you are a parent.

The following are recommendations to make this time a little easier:

  • Ask that your pregnancy be monitored carefully.
  • You may want to avoid early preparation for the baby’s arrival. Some couples find it helpful to request that baby showers be held until after the arrival of the baby.
  • Some people will make suggestions about what you should do or not do to make this pregnancy successful because they are also invested emotionally in your pregnancy. The easiest way to handle their suggestions is to listen, and then do whatever you, your partner, and the medical team feel is best.
  • Your birth experience might be bittersweet because memories may resurface about your loss. You will probably need to do some grieving in addition to celebrating your new baby.
  • Your parenting may be influenced by your past loss so moments of panic might occur, especially when the new baby is ill, or too quiet.
  • You may feel the need to protect yourself from more sorrow so you might be cautious bonding with your new baby until you’re certain he or she is safe and healthy.
  • If you feel you are struggling, speak to your healthcare provider about possible support groups or counselors who could help you through this difficult time.

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Last Updated: 08/2015

Compiled using information from the following sources:

It is worth remembering that most couples will have a successful pregnancy the next time, even after three miscarriages in a row.

If you had an ectopic pregnancy, your chances of having a successful pregnancy in the future are good. Even if you have only one fallopian tube, your chances of getting pregnant are only slightly reduced. For most women, an ectopic pregnancy is a one-off.

Having a molar pregnancy doesn’t affect your chances of getting pregnant again, and the risk of having another molar pregnancy is small (about 1 in 80).

Find out more about the likelihood of miscarrying again.

Your mental health

Losing a baby can impact on how you and your partner feel during a next pregnancy. Be kind to yourselves. It’s understandable if you’re not enjoying trying again and it’s natural to feel some anxiety about how this pregnancy will progress.

If you are struggling with negative feelings, you may need help. Up to 1 in 5 women develop mental health problems during pregnancy or in the first year after childbirth, including anxiety and depression. Some women even experience post-traumatic stress after pregnancy caused by miscarriage.

If you or your partner are feeling low, don’t hide your feelings or suffer in silence. You are not alone. Tell your GP and midwife how you feel. They will help you access the support you need.

You can also talk to a Tommy’s midwife free of charge from 9am–5pm, Monday to Friday on 0800 0147 800 or email them at .

Find out more about taking care of your mental health in pregnancy.

Your antenatal care

You can ask for an early scan or extra scans during pregnancy as part of your antenatal care, although these may not be provided. Extra scans won’t guarantee anything or predict how your pregnancy will progress, but it may give you some peace of mind.

Don’t feel that you have to keep your next pregnancy secret – talking to your friends or family might really help. You can also join our Parenting After Loss support group that you can join.

Our midwives are at the end of the phone if you need to get advice or information on trying again after a miscarriage. You can speak to them from 9am–5pm, Monday to Friday on 0800 0147 800.

‘No need to wait to try again after miscarriage’ advice

“Women who suffer a miscarriage should try for a baby again within six months, a major study has found,” the Daily Mail reports.

Current guidance from the World Health Organization recommends couples wait at least six months before trying to conceive again after a miscarriage. But the researchers decided to investigate the validity of this recommendation as it was based on a single study from women in the developing world.

The researchers looked at information taken from around 1 million women from 11 different countries around the world. It found no more adverse outcomes for women who get pregnant less than six months after a miscarriage compared to those who wait. Moreover, a reduced risk of miscarriage and preterm birth was found for these women.

So this study suggests these guidelines should be reviewed and that couples be advised that delaying pregnancy doesn’t necessarily improve outcomes.

If you have had a miscarriage, you should avoid having sex until all of your miscarriage symptoms have gone. Your periods should return within four to six weeks of your miscarriage, although it may take several months to settle into a regular cycle.

Not every woman will feel physically and/or emotionally ready to try for another pregnancy. Charities such as the Miscarriage Association can provide advice and support about trying for another pregnancy.

Where did the story come from?

The study was carried out by researchers from the University of Malta and the University of Aberdeen and did not receive any funding.

The study was published in the peer-reviewed medical journal Human Reproduction Update and the authors declare no conflict of interest.

The media generally reported the story accurately, acknowledging that women are more likely to have a successful pregnancy if they conceive sooner after a miscarriage, rather than waiting.

The Daily Mail suggests that women who have a miscarriage “should try for a baby again within six months”. However not all women will feel emotionally ready to try again for a baby so soon.

What kind of research was this?

This was a systematic review and meta-analysis aiming to see if becoming pregnant less than six months after miscarriage is associated with adverse outcomes in the next pregnancy, compared with getting pregnant more than six months later.

Meta-analyses are a useful way of summarising many studies looking at the same outcomes, in this case adverse pregnancy outcomes.

However, this type of study will only ever be as good as the individual studies included, and weaknesses from these studies will be brought into the analyses.

The studies included were 13 cohort studies and three randomised controlled trials, from 11 different countries.

Cohort studies are a good way of looking at a link between two factors, but cannot prove that one – falling pregnant before six months – causes another – future pregnancy outcomes.

What did the research involve?

Researchers compared the results of 1,043,840 women from 16 trials. They then pooled the results of 10 similar trials, involving 977,972 women. They compared the difference in pregnancy-related outcomes between women who fell pregnant less than six months after having a miscarriage, and those who fell pregnant more than six months after miscarriage.

They looked at outcomes, including:

  • further miscarriage
  • preterm birth
  • stillbirth
  • pre-eclampsia (which causes high blood pressure)
  • low birthweight

The results were analysed and the risk of each outcome for the two groups of women (less than six months to pregnancy or more than six months to pregnancy) was calculated.

What were the basic results?

Results showed that in women with less than six months between miscarriage and pregnancy compared to those with a six months or more interval, there was a:

There was no significant difference between women with less than six months or more than six months between miscarriage and pregnancy for still birth, low birthweight or pre-eclampsia.

How did the researchers interpret the results?

The researchers concluded: “The results of this systematic review and meta-analyses show that an IPI of less than six months is associated with no increase in the risks of adverse outcomes in the pregnancy following miscarriage compared to delaying pregnancy for at least six months.”

In fact, there is some evidence to suggest that chances of having a live birth in the subsequent pregnancy are increased with an IPI of less than six months.

They go on to add: “there is now ample evidence to suggest that delaying a pregnancy following a miscarriage is not beneficial and unless there are specific reasons for delay couples should be advised to try for another pregnancy as soon as they feel ready.”

Conclusion

This study shows that getting pregnant sooner after a miscarriage results in no more adverse outcomes compared to waiting for more than six months.

In addition, there appear to be better outcomes in terms of a lower risk of further miscarriage and possibly preterm birth. It should be pointed out that for preterm birth the result only reached statistical significance when one of the relevant studies was excluded, which limits our confidence in this result.

This study has strengths as it included a large number of women from many different countries. However, it also has limitations:

  • The way data was collected from the original studies varied. Some used mother’s recall while others gained information from databases – therefore the quality of data varied.
  • Studies had different definitions of miscarriage. While some included only spontaneous abortion (miscarriage), others did not distinguish between spontaneous and induced abortion.

However, there are a number of confounding factors that influence pregnancy outcomes, including:

  • maternal age
  • ethnicity
  • social class
  • smoking
  • alcohol
  • BMI
  • previous obstetric history

Other than maternal age, the included studies varied in addressing these potential confounding variables, which could have led to an over- or under-estimation of results.

Miscarriages are fairly common. Among women who know they’re pregnant, it’s estimated one in six of these pregnancies will end in miscarriage.

Recurrent miscarriages (losing three or more pregnancies in a row) are far less common, affecting only around 1 in a 100 women.

If you do want to get pregnant again, you may want to discuss it with your GP or hospital care team. Make sure you are feeling physically and emotionally well before trying for another pregnancy.

The Miscarriage Association provides more advice about trying for another pregnancy.

Analysis by Bazian
Edited by NHS Website

Links to the headlines

Women who lose their baby to miscarriage told to try again within six months because it can reduce the risk by a fifth

Daily Mail, 30 November 2016

Successful pregnancy more likely sooner after miscarriage, say researchers

BBC News, 30 November 2016

Try again for a baby within six months of miscarriage for best chance of success – new research

The Daily Telegraph, 30 November 2016

Women who conceive within six months of miscarriage are ‘more likely to get pregnant’, study finds

The Independent, 30 November 2016

Links to the science

Kangatharan C, Labram S, Bhattacharya S.

Interpregnancy interval following miscarriage and adverse pregnancy outcomes: systematic review and meta-analysis

Human Reproduction Update. Published online November 17 2016

How I Learned to Trust My Body Again After a Miscarriage

Photo: Paul Velgos /

For my 30th birthday last July, I received the best present in the world: My husband and I found out we were pregnant after six months of trying. It was a muggy midsummer evening, and we lay on our Edison light-lit porch looking at the fireflies and dreaming about our future. I had an inkling it was a boy, while hubby guessed girl. But it didn’t matter-we were going to be parents.

About a week later, I woke up in the middle of the night with sharp cramps and ran to the bathroom. I saw a speck of bright red blood on the toilet paper, and while in my heart I knew, I tried to go back to bed.

The next two hours I was up tossing and turning, the pain becoming more severe and the bleeding heavier. This confirmed my biggest fear: I was having a miscarriage. As I lay there sobbing and shaking uncontrollably, my husband held me tightly saying, “It’s going to be okay.”

But was it? I felt numb, and my mind flooded with endless thoughts and questions. Was it my fault? Could I have done anything differently? Was it that glass of wine I had last week? Why me? I was dumb to get so excited so soon, I should have been more practical. The conversations I had in my head were endless and for the first time in my life, I felt truly heartbroken.

This is a natural reaction referred to as “mother’s guilt,” says Iffath Hoskins, M.D., a clinical associate professor in the department of obstetrics and gynecology at NYU Langone Health, who treats recurrent miscarriage.

“There is an element of grieving, but you can’t blame yourself,” Dr. Hoskins tells me. She explains that the majority of miscarriages are actually caused by chromosomal abnormalities. “It’s Mother Nature’s way of saying this pregnancy wasn’t meant to be, and in most cases, there’s nothing you could have done,” Dr. Hoskins says. On a hopeful note, she says the chance of going on to have a successful pregnancy is in the 90 percent range.

As I opened up about my experience to friends and family, I realized miscarriages are far more common than I had thought. According to the American Pregnancy Association, 10 to 25 percent of pregnancies will end in miscarriage, with chemical pregnancies (a loss shortly after implantation) accounting for 50 to 75 percent of all miscarriages.

Even women I look up to with seemingly perfect lives and families revealed their secret stories of loss. Suddenly, I didn’t feel so alone. I felt a strong sense of connection, sisterhood, and gratitude for being able to share my story, while encouraging other women to share theirs too. (Related: Shawn Johnson Opens Up About Her Miscarriage In an Emotional Video)

In this moment, I knew my husband was right: I was going to be okay.

We decided to take a few months off from trying to conceive so I could heal both physically and emotionally. When September came, it felt like a good time to start trying again. Since I had been pregnant before, I thought it would come easier for us this time. Each month I just “knew” I was pregnant, only to be greeted by yet another blank pregnancy test followed by good ol’ Aunt Flo.

I’d map out elaborate scenarios of how I’d tell my family each month. In November, I planned to share the news during our annual Thanksgiving gratitude ritual. While everyone went around the table sharing what they were grateful for, I would say “I’m eating for two,” and laughs, hugs, and toasts would ensue. Unfortunately, I never got to live out these scenarios.

After three months of negative pregnancy tests, I began to lose hope and wondered what was wrong with me. So at the end of November, I decided to try something a little bit out-there-and made an appointment with Jo Homar, a clairvoyant spirit messenger and intuitive healer I was referred to who offers a variety of services including medical intuitive readings and reiki healing sessions. After a phone session with her, she told me it was my mindset that was holding me back from getting pregnant and that the baby would come when the baby was ready-apparently not until around the fall of 2018. While at first I felt a bit discouraged and impatient, I also felt a huge sense of relief. (See also: Can Reiki Help with Anxiety?)

I followed Homar’s advice and deleted all my apps and stopped trying that month. All of a sudden, a huge pressure was lifted from me. I ate loads of salmon avocado maki rolls, had fun sex with my husband only when we were in the mood, got wired off Nitro coffees, and made time for girls’ nights filled with tacos, guacamole, and yes, tequila! For the first time in a year, I was totally okay with my period coming.

Except it didn’t. To my surprise, two weeks later, I got my positive pregnancy test! “A Christmas miracle!” I shrieked to my husband.

No, I don’t think it was magic, but I also don’t think it was a coincidence that the month we stopped trying we got pregnant. I attribute our success to one big thing: trust. By trusting my body and the universe, I was able to let go of all the fear that was blocking baby from coming, and allow for it to just happen. (And trust me-there was a lot of fear.) And while experts don’t yet know how exactly stress and anxiety can impact fertility, preliminary research shows a connection between stress and fertility, backing up the whole “you’ll get pregnant when you stop trying” thing. (More on that here: What Ob-Gyns Wish Women Knew About Their Fertility)

So how the heck do you ditch the fear and trust in your body when all you want more than anything is to be pregnant now? Here are five tricks that helped me shift my mindset.

Take a break.

The period trackers, ovulation predictor kits, and $20 pregnancy tests can be extremely overwhelming (and expensive), making the whole process more like a science experiment. Since obsessing over the tracking was literally driving me crazy and consuming my thoughts, taking Homar’s advice and letting it go for a bit was huge for me. If you’ve been trying for a while, consider taking a break from all the tracking and just go by how your body feels. There’s nothing worse than “honey, I’m ovulating” sex, and there’s something special about being surprised by a missed period.

Have more fun.

Let’s be real: The whole trying-to-conceive process is far from glamorous, especially when you’re living by an ovulation timeline or counting down the dreaded “two-week wait.” That’s why Homar suggests focusing on adding more fun into your life. “When it comes to the two-week wait, you can look at it from two viewpoints. Either you can remain frozen about the ‘what if’ or you can live life,” Homar says. “Pregnancy is life, so why not choose to live life to the fullest during that period? If your focus is on fun, joy, and life, then that is what you are sending positive energy towards, which can result in a successful pregnancy.”

Develop a meditation practice.

Daily meditation has been one of the most transformative practices in my wellness toolkit. I use the Expectful meditation app, which has specific meditations for those preparing to conceive, like “Trusting the Body.” They even created a free Pregnancy Loss Support Guide including meditations and expert advice. (Related: 17 Powerful Benefits of Meditation)

Expectful cofounder and community guide Anna Gannon says the app helps women who are trying to conceive manage their emotions and be in the present. “Meditation isn’t a cure, but it’s a tool,” Gannon says. “It’s a prenatal vitamin for your mind.” Not to mention, studies show meditation can help enhance fertility, balance hormones, and reduce stress. Win, win, win.

Nourish your body.

For a while, I was obsessed with following the “perfect” fertility diet, and wouldn’t even allow myself the occasional cup of coffee. (Related: Can Drinking Coffee *Before* Pregnancy Cause a Miscarriage?) But instead of focusing on becoming “fertile,” experts say you should focus on improving your overall wellness. Aimee Raupp, acupuncturist and author of Yes, You Can Get Pregnant, explains that your fertility is an extension of your health. “Celebrate little victories like having fewer headaches or not feeling as bloated, and know that your fertility is improving along the way,” Raupp says.

Envision your future.

When I felt hopeless, I envisioned my life with a baby. I’d fantasize about my belly growing, and hold my belly in the shower, sending it love. The month before I got pregnant, I got a temporary tattoo that said, “Actually you can,” which reminded me that my body really can do this.

“If you can believe it, you can achieve it,” Raupp says. She recommends spending time in visualization thinking about baby clothes, the colors of your nursery, and what life will be like with a little one. “We’re programmed to think of the worst case scenario, but when I ask clients ‘If you quiet your mind enough and get in touch with your heart, do you believe you will have this baby?’ 99 percent of them say yes.” Believe it will happen for you too. (More: How to Use Visualization to Achieve Your Goals)

  • By By Rachel Kaczynski

Getting Pregnant the First Time Was Easy — So Why Has It Been So Hard the Second Time?

One month after our Mexican honeymoon, I found out I was pregnant. There must be something to the “there’s something in the water” claim, because I was on the pill. To be fair, we were having way more sex than normal (did I mention it was our honeymoon?), but other than being in Mexico, nothing else had changed. Because of this, my husband and I did not experience the “trying” phase of having our first baby. We weren’t trying to get pregnant, it just happened.

My pregnancy was standard—there were no scares, no major concerns, and I even asked my doctor if there was a discount plan I could go on to save money because I didn’t feel it was necessary to see him once a month: I could check my own blood pressure. My daughter was born without any medical concerns. Besides the surprise factor, there was nothing about my experience that was worrisome. I mean, I got pregnant on the pill. Who does that?

Before our daughter, my husband claimed he wanted four kids, but after my daughter, we spent a solid year believing we were a one-and-done family. My daughter is delightful, but one child turned out to be far more work than we had anticipated. Unexpectedly and shortly after our daughter’s first birthday, we found ourselves fostering my newborn nephew. It was the most challenging adjustment of our lives—but it also showed us we weren’t done having kids.

When we began fostering our nephew, I did not consider his living with us would be permanent. Social workers, lawyers, and case managers frequently reminded us the ultimate goal was unification with his birth parents. This led us to decide to try to have a second baby.

Once again, I got pregnant instantly. This time, I went to my doctor because I had a never-ending period. I remember the doctor asking how I was feeling. “Tired,” I answered, “Very, very tired.” I had two kids under two and didn’t put much thought to it. My doctor glanced down at my paperwork. “Well yeah, you’re tired! You’re pregnant!” A week later, I ran a marathon and a week after that, while at work, I miscarried in the student bathroom and carried myself back to my classroom to teach.

Struggling to Get Pregnant? You’re Not Alone

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Logically, it made sense. Before I realized I was pregnant, I had been training for a marathon in summer temperatures, I had been fueling for one person, drinking water for one person, and drinking large coffees every day to combat my tiredness. I had gone out for a few happy hours with friends. Still, the heaviness of the experience hit me harder than I anticipated. Instead of breaking me, it fueled my desire to have another kid, and I decided I would do everything differently. I drank more water and took prenatal vitamins preemptively. I did everything right.

Once again, we got pregnant right away. This time felt better: I had raging morning sickness and acne. I was a little nervous about miscarrying again, but honestly, I thought the first miscarriage was a fluke; it wouldn’t be repeated, because I was doing everything correctly this time around.

During the week of my eight-week appointment, I noticed my nausea stopped. I didn’t think much of it. The first trimester was almost over and a Google search revealed this is usually when morning sickness subsides. I told my husband to not worry about taking off work, and I went to the appointment alone. I went through the awkward moments of the eight-week appointment: I got naked and put on my robe and got mentally ready to put my feet up in stirrups.

My doctor, who was the one who weathered my first pregnancy and delivery, walked into the room and started the process. My nerves grew as his brow furrowed. I heard him mutter, “I don’t like what I’m seeing.” I opened my mouth to make a joke, but it stayed open and silent. I knew this wasn’t going to be a funny moment. He gently placed his hand on my protruded knee and explained to me what he saw: There wasn’t a heartbeat. A primal noise escaped from my still-parted lips and cascaded into sobs.

Handing me an ultrasound, my doctor stoically told me he liked this particular one, because I was able to see the umbilical cord connecting my baby to myself. He proceeded to explain my options: I could wait for my body to recognize the fetus wasn’t viable, or I could come in and he could perform a D&C and remove the tissue. “Take the weekend and I’ll call you on Monday,” he suggested. When I continued to stare at my hands he confidently stated, “I’m not worried about your chances of having another kid. You’ve successfully carried a pregnancy to term. You’ll be fine.”

Navigating my way through a waiting room full of women with their hands on their bellies, I realized what instilled confidence in my doctor was the root of my fear—my first pregnancy had been so easy, so carefree. Why was it suddenly so hard to stay pregnant? Many women I know have successful and easy first pregnancies but go on to struggle with infertility later. Wasn’t the fact that I had no problems before reason to be concerned that I had now had more unsuccessful pregnancies than successful ones?

I went on to miscarry on Christmas day, unprepared for the physical toll it would take on my body. Laying in bed with my husband, I felt a pop and felt liquid soak my sweatpants. I sat on the toilet trying to get my vision to stabilize while my husband sat outside the locked bathroom, too terrified to leave me on my own.

My doctor did not explain the pain would be so severe, I would become lightheaded. He didn’t tell me how I would know if I was done. This miscarriage had escalated from the last. I had no idea if what was happening was normal or if I should have been concerned. Everything about this miscarriage was unexpected—the way it felt, the way it looked, the time it took.

Physically and emotionally, I was done. Without needing to talk about it, my husband and I simply stopped trying. We went on to adopt our nephew and didn’t have a conversation about trying for another baby until recently, when one day, my husband turned to me and apologized before saying he wanted to try for one more kid.

Secretly, I have been feeling the same itch in my chest for some time. Every time our kids have mentioned wanting a baby in the family, I’ve silently thought, Me too. But I know going into this next pregnancy will be different. Instead of spending the first few months with anticipation and joy, it will be clouded by fear. What if I miscarry again? Instead of wanting to keep the pregnancy a secret between my husband and myself, it’ll be a secret kept in fear that the more people who know I am pregnant, the more I will have to face if there is no birth.

Each time I get excited about the prospect of trying for another baby, I remember I may not get another baby. Even if I get the blue plus sign on the pregnancy test, it doesn’t mean I will hold the pregnancy to term. I think back to the joy and relief in those previous pregnancy test results and know the next blue plus won’t just elicit excitement—it’ll bring doubt. And, I don’t know how long that fear will embed itself into the pregnancy. If I make it to the first trimester, will I feel safe? Will decorating a nursery or picking out names feel like I’m testing fate?

This next pregnancy will be the first time I will expect something to go wrong. Not only am I afraid I won’t have another baby, but I am afraid of how this fear can color the whole pregnancy. The only thing we have left to do is try and hope for the best.

Pregnancy after miscarriage

There is “no need to delay pregnancy after miscarriage,” says BBC News. The website reports that a large study has found that, contrary to current guidelines, conceiving within six months of a miscarriage does not pose a greater risk of the mother having another miscarriage.

How long a couple should wait before trying for another pregnancy after a miscarriage has long been debated, with opinions varying. Current World Health Organization (WHO) guidance recommends that women wait for at least six months before trying to conceive again. This valuable new study examined the medical records of over 30,000 Scottish women and found that conceiving within six months was associated with lower risks of second miscarriage, ectopic pregnancy or termination than conceiving 6–12 months after a miscarriage.

However, the study has several limitations. Most importantly, it cannot tell whether delays between miscarriage and subsequent pregnancies were due to couples choosing to wait before trying again or caused by difficulties in conceiving, which may also be related to problems when pregnancy does occur. Overall, the study suggests that pregnancy can be successful soon after miscarriage, although it is important that prospective parents feel emotionally and physically prepared before trying again.

The study was carried out by researchers from the University of Aberdeen and funded by the Chief Scientist Office in Scotland. It was published in the peer-reviewed British Medical Journal.

The news stories generally reflect the findings of this well-conducted study, but in suggesting that waiting to conceive again is the cause of increased pregnancy complications they have not identified the important considerations that must be made when interpreting the possible reasons behind these findings. The tone of some newspapers might also suggest that the findings of this study constitute new advice on when to conceive again after pregnancy, but it should be noted that there has been no change in the official advice of the World Health Organization, which suggests women should wait at least six months before trying to conceive again.

This was a retrospective cohort study looking at a large population of pregnant women receiving care at Scottish hospitals between 1981 and 2000. The aim was to determine the optimum time interval to leave between miscarriage and trying to conceive again, looking particularly at how this interval was associated with the risk of further miscarriage, ectopic pregnancy, or other pregnancy-related and labour complications.

It is recognised that women who suffer a first miscarriage are at slightly higher risk of miscarrying again, and also possibly of other complications in pregnancy. How long a couple should wait before trying for another pregnancy after a miscarriage has long been debated, with varying opinions between different clinicians. Some believe it is best for women to wait in order to increase the chances of full physical and emotional recovery before trying again, while others believe that a delay will not improve chances of a better outcome and that getting pregnant again fairly soon could help the couple recover more quickly from the loss. The issue is further complicated by the increasing number of women who are having children after the age of 35, as waiting longer at this age can further decrease their chances of conceiving.

Current guidelines from the World Health Organization (WHO) recommend that women should wait for at least six months before trying to conceive again. This study is reportedly one of the first to try to examine the evidence supporting this time interval in the developed world.

This research used data from the Scottish morbidity records that collect information on all hospital admissions in Scotland. The records are reported to be 99% complete since the late 1970s and undergo regular quality assurance checks.

The researchers collected data on women who had a miscarriage recorded for their first pregnancy between 1981 and 2000 and who went on to have a second pregnancy. They looked at the dates of the first pregnancy-related records and the second pregnancy records and divided women into groups according to the time interval between miscarriage and next pregnancy: fewer than six months, 6–12 months, 12–18 months, 18–24 months and over 24 months. They excluded women with multiple pregnancies (e.g. twins) and women with an interval of less than four weeks between hospital records, as these visits were presumed to relate to the same pregnancy. In their analyses, they used the current recommended interval of 6–12 months as the reference category against which all the other time intervals were compared.

The main outcomes of interest in the second pregnancy were miscarriage, ectopic pregnancy, termination, stillbirth and live birth. Further outcomes examined included pregnancy and labour complications of pre-eclampsia, placenta praevia (placenta lying over the cervix), placental abruption (placenta detaching from uterus), premature delivery (less than 37 weeks) and very premature delivery (32 weeks or less), and low birthweight infants (less than 2,500g). In their analyses the researchers adjusted for possible confounders of the mother’s age, socioeconomic status, smoking status (known for only 57% of women) and other pregnancy-related factors such as induction of labour.

A total of 30,937 women were included in the study. Of them, 41.2% conceived within six months of a miscarriage, 25.2% after 6–12 months, 9.6% after 12–18 months, 6.4% after 18–24 months and 17.6% after 24 months. In general, women with the shortest interval between pregnancies tended to be older (26 on average), be of a higher social class and be less likely to have smoked.

The highest rate of successful second pregnancy was among the women who conceived within six months of their first pregnancy, 85.2% of whom gave birth to a live baby. The lowest rate was among women who conceived again after 24 months, 73.3% of whom gave birth to a live baby. Compared with women who had the standard interval of 6–12 months between pregnancies, women who conceived within six months were:

Women with more than 24 months between pregnancies were significantly more likely to have an ectopic second pregnancy (OR 1.97, 95% 1.42 to 2.72) or termination (OR 2.40, 95% CI 1.91 to 3.01) than women who conceived within 6–12 months. However, they were not at increased risk of second miscarriage.

Compared to those in the 6–12 months group, women conceiving within 18–24 months were at no increased risk of any adverse outcomes, and women conceiving between 18–24 months were at increased risk of termination only. The risk of stillbirth did not differ between any of the groups.

Compared to the 6–12 months group, women conceiving within six months were less likely to have a caesarean section (OR 0.90, 95% CI 0.83 to 0.98), premature delivery (OR 0.89, 95% CI 0.81 to 0.98) or low birthweight baby (OR 0.84, 95% CI 0.71 to 0.89). However, these were the only significant differences in pregnancy-related complications found between the 6–12 month group and any other group.

The researchers conclude that women who conceive within six months of an initial miscarriage have the best reproductive outcomes and lowest complication rates in their second pregnancy.

This is a valuable study that appears to be one of the first to examine how the time interval between first miscarriage and conceiving a second pregnancy affects pregnancy outcomes in the developed world. How long a couple should wait before trying for another pregnancy after a miscarriage has always been debated, with varying opinions among clinicians. The WHO currently recommends that women should wait for at least six months before trying to conceive again but many believe that, given the increasing age of first-time mothers in the developed world, delaying pregnancy further could increase the chance of difficulty conceiving or having pregnancy-related complications.

The main findings of this study were that, compared with conceiving between 6–12 months after first miscarriage, conceiving within six months was associated with decreased risk of second miscarriage, ectopic pregnancy or termination. Conceiving after 24 months was associated with increased risk of ectopic pregnancy or termination.

The study is well-conducted and has strengths in its large size (over 30,000 women) and use of highly complete, quality-assured medical records. However, this study was dealing with a complex issue and there are several factors to consider, such as whether or not delays in conceiving were actually deliberate. While the time interval between pregnancies can be accurately assessed from records, this cannot tell us how long the couple actually waited before trying to conceive again.

This is an important issue because while a woman may not have become pregnant again until more than six, 12, 18 or 24 months after her first miscarriage, she may have been trying to conceive again within six months of the first pregnancy. Underlying biological reasons may be behind both difficulty in conceiving and the increased risk of complications when pregnancy did eventually occur. Overall, it is difficult to conclude that waiting, as opposed to having trouble conceiving, is associated with increased risk of complications.

There are a number of other points of discussion, outlined below.

  • There may be other differences between the groups of women who conceived at different times after their first miscarriage, which may be affecting the results (called confounding). The researchers adjusted for some factors that could affect results (such as age and socioeconomic status), but there may be other unknown or unmeasured factors having an effect.
  • Although the records were quality-assured and 99% complete, they can only provide information on women who actually presented for medical attention with their first and second pregnancies. For example, they may not include details of any women that became pregnant but miscarried within a couple of weeks and did not present to their doctor, either through not knowing they were pregnant or knowing but choosing not to seek medical advice.
  • There is some possibility that women were placed into the wrong time interval groups between miscarriage and their next pregnancy. Documentation of first miscarriage in medical records may not be precise as to the time that miscarriage actually occurred; also with the subsequent pregnancy there is the possibility of inaccurate recording of pregnancy duration due to thinking a pregnancy was of fewer or greater weeks’ gestation than it actually was (though current ultrasound technology makes this error less likely).
  • It is encouraging that for all women who had previously miscarried, a high proportion had a successful subsequent pregnancy, regardless of how much later the subsequent pregnancy occurred (the lowest rates were in the group who had a greater than 24-month interval between the pregnancies, but almost three quarters still had a successful pregnancy resulting in a live baby).

Despite the limitations of the research, these findings suggest that a successful pregnancy can be achieved within six months of a miscarriage. The decision of when to try and conceive again is fundamentally the choice of the individual couple, and the most important point is that the prospective mother feels physically and emotionally ready to try again. As the researchers of this study have also said, it is important for women who have miscarried to receive support and counselling on how to optimise their own health before and during pregnancy. Part of this guidance should include information on the possible risks and benefits of delaying further pregnancy, which could help prospective parents to make their own informed decision on when to try conceiving again.

Analysis by Bazian
Edited by NHS Website

No need to delay pregnancy after miscarriage

BBC News, 6 August 2010

Doctors say no baby break needed after miscarriage.

Daily Mirror, 6 August 2010

Women who miscarry should try to conceive again within six months

The Guardian, 6 August 2010

Don’t delay the next try after a miscarriage, women warned

Daily Mail, 6 August 2010

Love ER, Bhattacharya S, Smith NC, Bhattacharya S.

Effect of interpregnancy interval on outcomes of pregnancy after miscarriage: retrospective analysis of hospital episode statistics in Scotland

BMJ 2010;341:c3967

Sept. 12, 2000 — In this day and age, women are waiting later in life to have kids, and it can feel like getting pregnant isn’t as quick and easy as it once was in the first place. Morever, many women discover that, once pregnant, it may still be too soon to celebrate. Now research backs that up by showing that women who try unsuccessfully for a year or more to conceive a child may be at higher risk for miscarriage when they do finally become pregnant.

A study of more than 1,500 women (ages 15 to 44) found that those who were trying to get pregnant a year or longer were almost two times more likely to have a miscarriage — pregnancy loss before the 28th week — compared with women who conceived soon after trying.

Lead author Ronald H. Gray, MD, who published the findings in the September issue of the American Journal of Public Health, says the study adds to other work suggesting that at least some women who appear to be having trouble getting pregnant may actually be having miscarriages that occur so early that the woman never realizes she was pregnant. Gray concludes that more research on why women with delays in getting pregnant — a condition some doctors call subfertility if it lasts for a year or more — have more miscarriages is needed.

“It will help us to better manage the care of women who have subfertility and recurrent pregnancy losses,” Gray says in a press release issued by Johns Hopkins School of Public Health in Baltimore, where he is professor of population and family health sciences.

In the study, women who did not have a verified pregnancy for a year or more after they began trying had a miscarriage rate of 23%, while those who became pregnant soon after they began trying had a miscarriage rate of just 14%.

Also, although older age is a recognized risk factor for miscarriage, the study found that subfertility may have more of an effect on younger women.

Not conceiving after miscarriage

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