Pregnancy after miscarriage - when can you try again? .

Pregnancy after miscarriage - if and when is it possible?

For couples trying to have a baby, miscarriage is one of their worst nightmares. It's no wonder, then, that pregnancy after a miscarriage can cause a lot of anxiety - especially if there have been more miscarriages. It is important to know that the loss of a pregnancy does not have to mean that the dream of having a child has been cancelled and it is worth trying to continue. According to the recommendations of the Polish Gynaecological Society, attempts can be made 3 months after the miscarriage (1).

How to prepare? What tests should be carried out?

When can you get pregnant after a miscarriage?

Many couples who have experienced a pregnancy miscarriage wonder whether it is possible to get pregnant again after a spontaneous miscarriage. Doctors state unequivocally that there are no contraindications to trying for a baby again. However, it is worth knowing how long after a miscarriage it is possible to become pregnant.

Although physically conception can occur already in the next cycle, specialists of the Polish Gynaecological Society recommend waiting a further three months before trying (2). During this time, the body can adequately regenerate and prepare for the next pregnancy.

This is also the time for additional diagnostics or seeking help from a therapist, which will support the couple during the difficult time after a miscarriage.

Causes of miscarriages

Miscarriage can have many different causes, depending on numerous external and internal factors (3). By far the greatest number of spontaneous miscarriages occur in the first weeks after conception, and many women do not even know they were pregnant. Such early miscarriages are most often the result of lethal defects of the embryosuch as chromosome aberrationswhich prevent the further, normal development of the foetus and pregnancy.

Other causes of miscarriages include:

• defects in the structure of the uterus
• blood coagulation disorders (congenital or acquired thrombophilia), 
• endocrine disruptors (PCOS, thyroid disease),
• infections during pregnancy (especially rubella or toxoplasmosis infection).

Risk factors that also need to be considered are:

• obesity,
• stimulants (alcohol, nicotine, drugs), 
• age over 40
• and folic acid deficiencies.

Advanced diagnostics enable in-depth investigations into the causes of miscarriage, increasing the chances of a happy ending to the next pregnancy.

Recurrent miscarriages - diagnosis

With recurrent (habitual) miscarriages, they say, when spontaneous pregnancy loss has occurred during at least three consecutive pregnancies (4). Such a situation is an indication for in-depth diagnostics to help pinpoint the causes of failure. A prompt diagnosis and implemented treatment will enable the maintenance of pregnancy after miscarriages and fulfil the dream of having your own offspring.

Pregnancy after miscarriage - what tests to perform?

The diagnosis of miscarriage is not straightforward, mainly because of the multitude of factors that can cause pregnancy loss. The attending physician will decide what tests need to be performed after a miscarriage.

Among the most commonly recommended are:

• Peripheral blood count,
• determination of hormone levels (TSH, FSH, LH, progesterone and oestradiol),
• Uterine ultrasound.

After miscarriages, it is also a good idea to perform genetic testing - especially if previous tests have shown nothing. Karyotype tests are carried out on both parents-to-be to highlight any chromosomal variations that the embryo has inherited that could cause miscarriages.

Women are most often screened:

• for congenital thrombophilia (V Leiden, MTHFR and prothrombin gene testing),
• KIR - KIR receptors are significantly involved in placenta formation. Abnormalities within them can cause abnormalities in its formation,
• HLA-C - expression of tissue compatibility antigens (in both partners).

If a uterine curettage has been performed after a miscarriage, the collected material is also subjected to tests that can indicate the cause of the spontaneous termination of pregnancy.

Pregnancy after miscarriage - a summary

A miscarriage is a very difficult moment in trying to have a baby.

It involves not only physical ailments but, above all, psychological ones. What parents should know after a loss is that another pregnancy after a miscarriage is still possible.

However, it is worth wait 3 months before making further efforts. After this time, the woman's regenerated body will be prepared to become pregnant again. This period is also a good time to perform additional tests to help pinpoint the cause of the miscarriage and allow for appropriate treatment or preparation. This time is also worthwhile for mental stabilisation after a miscarriage. In this way, a second pregnancy after a first miscarriage can end in a happy outcome and the dream of having your own child can come true.

Footnotes:

1. Recommendations of the Polish Society of Gynaecology on selected pathologies of early pregnancy and management of pregnancy after in vitro fertilisation. POLISH GYNAECOLOGY (2015).
2. [Iidem]
3. Palka, Agnieszka. "Habitual miscarriages-causes." (2012).
4. MICHALAK, MAGDALENA, DARMOCHWAŁ-KOLARZ, DOROTA, LESZCZYŃSKA-GORZELAK, BOŻENA, et al. Causes, diagnosis and treatment of habitual miscarriages-part I. GinPolMedProject, 2011, vol. 1, pp. 15-30.

Substantive consultation:

dr n. med. Artur Kobielski - Specialist gynaecologist-obstetrician