What is a Miscarriage?
A miscarriage is a spontaneous pregnancy loss before the 20th week of gestation. A miscarriage can happen for many reasons, including:
- Problems with the baby’s chromosomes can contribute to 50% of losses.
- Women over 40 years old are at a higher risk of pregnancy loss.
- Problems with reproductive organs such as incompetent cervix, thin uterus lining, etc.
- Physical trauma such as falling, car accidents, and violence.
- Health conditions such as diabetes, high or extremely low body weight, high blood pressure, food poisoning, smoking, alcohol, and illegal drugs can increase the risk of a miscarriage.
About 1 in 4 pregnancies end in miscarriage, and most women are thankfully able to go on to have healthy future pregnancies. Only about 1% of women will experience a repeated miscarriage. The predicted risk of a 2nd miscarriage is no different from anybody else’s – and remains at about 1 in 4 pregnancies or 20%. However, after two consecutive miscarriages, the risk of another miscarriage increases to about 28%; after three or more miscarriages, the risk of another miscarriage is about 43%[1].
A torrent of feelings can be experienced after a miscarriage: loss, sadness, guilt, anxiety, and even anger. All these emotions are expected, and the grieving process following a miscarriage should not be rushed. Deciding to conceive again after a miscarriage can be stressful and often a painful decision to make. It is recommended that the parties wait until they feel emotionally and physically ready to proceed with another attempt at pregnancy.
How soon after a Miscarriage can another Conception Occur?
A woman can ovulate and become pregnant as soon as two weeks after a miscarriage. For some women, it can take several months for ovulation to occur.
After a first miscarriage, there might be no need to wait to conceive. There is no “rule” on when a woman should conceive after a miscarriage, but it seems safest to wait for at least one full menstrual cycle. The standard recommendation of at least three months after a miscarriage before conceiving was challenged in a study undertaken in 2016 that concluded: “there is no physiological evidence for delaying a pregnancy attempt after an early loss.”[2] However, everyone is different, and some women may wait many months or even years before deciding that they can attempt to conceive again.
With late-term losses, it may take months for a woman’s body and the pregnancy hormones to reset. In such cases, it is recommended that conception be delayed until the blood tests show that the pregnancy hormones have decreased to zero after the miscarriage. It is also recommended that the woman check her uterine lining to ensure it has returned to normal to optimize the chances of a subsequent pregnancy.
Pregnancy following a miscarriage can bring out anxiety over the potential subsequent loss of a future pregnancy. These feelings are perfectly normal, and it is recommended that both parties speak openly to each other, family, and friends to seek comfort. It may also be helpful for the parties to seek support from a counselor to discuss these genuine feelings and learn tools to handle the pregnancy better. Mental health is just as important, maybe more important, than getting the green light that the woman is physically healthy to proceed. It is okay to grieve the loss of a baby before thinking about continuing the journey toward parenthood.
[1] www.mayoclinic.org/healthy-lifestyle/getting-pregnant/in-depth/pregnancy-after-miscarriage
[2] Obstetrics & Gynecology 127(2):p 204-212 February 2016
My Surrogate had a Miscarriage.
Working with a surrogate adds another layer to the emotions that the Intended Parents feel over the loss of the pregnancy. When a pregnancy loss occurs between a couple, there is a sense of privacy. However, when a surrogate miscarriage occurs, there is no such privacy. Achieving a surrogacy pregnancy demands significant time, effort, and expense, making the loss even more devastating, particularly for intended parents who have previously struggled to conceive. It can signify the end of their fertility journey or their last attempt to have a biological connection to a child. For intended parents, a miscarriage may serve as a reminder of past challenges in achieving pregnancy, and they may grapple with feelings of guilt that their surrogate must experience both physical and emotional pain for their cause.
On the other hand, the surrogate confronts the physical and emotional symptoms of a miscarriage and often feels a deep sense of responsibility for the intended parents’ loss. They often feel responsible for the miscarriage because their bodies let them down, even though they carried prior uneventful and successful pregnancies. They may think that their intended parents are disappointed in them or that they will blame her. Despite not having a genetic link to the baby, the surrogate still experiences profound feelings of loss. For many surrogates, this may be their first encounter with miscarriage, leaving them emotionally unprepared for the trauma it brings.
In addition, it is entirely natural for communication between the intended parent and surrogate to slow down following a miscarriage. Both parties may require time to grieve and heal from the emotional impact. During this sensitive period, the counselor or surrogacy agency will play a crucial role in sustaining the relationship and providing guidance on re-establishing communication, especially as the parties prepare for another IVF transfer. Engaging in counseling is highly recommended for all involved, ensuring that each party can process their grief and offer support to one another.
Before proceeding with another transfer, the IVF doctor will likely request various blood tests, ultrasounds, and additional assessments. Their primary goal is to ensure the current pregnancy has been fully terminated, with no residual tissue remaining in the surrogate’s uterus. Additionally, the doctor will carefully assess the surrogate’s uterine lining to ensure it has adequately recovered and can support another pregnancy. These precautions are taken to maximize the chances of a successful future transfer for all parties involved.
Once testing confirms that the surrogate is ready to proceed, the IVF doctor will arrange another IVF transfer. Generally, this transfer occurs within three months of the original miscarriage, although additional time may be necessary for later-term miscarriages. However, it’s important to note that after evaluating the test results, the IVF doctor may suggest that the intended parents consider working with a different surrogate if it is deemed more appropriate for their situation.
Testing recommendations after Experiencing 2 or more Miscarriages:
Preconception testing (also known as genetic carrier screening) is done to identify whether a person carries a gene for specific genetic disorders. A baby receives two copies of each gene – one from each parent. For a baby to inherit a disorder, both parents must be carriers. The most common conditions identified through genetic carrier screening are:
- Cystic Fibrosis – a cell mutation that causes a protein to malfunction, leading to mucus buildup in the lungs, pancreas, and other organs.
- Fragile X Syndrome is associated with lower-than-average IQ, developmental delays, seizures, autism, and hyperactivity.
- Spinal Muscular Atrophy affects 1 in 6000 babies and causes weakening of the muscles.
- Tay-Sachs Disease is usually associated with Ashkenazi Jewish ancestry.
- Sickle Cell Disease is an inherited red blood cell disorder most common in Black or African American people but can affect any race. Many IVF clinics will recommend preconception genetic testing before undergoing an IVF transfer. This enables the Intended Parents to identify any negative hereditary traits and request a preimplantation genetic screening of the embryo(s) to identify these abnormal chromosomes and avoid implanting those embryos.
- Testing fetal tissue (Product of Conception Testing) is utilized to determine if the pregnancy loss resulted from a chromosomal abnormality. Regrettably, the fetal tissue is lost in many instances before thorough discussions about or investigation into this option can occur.
- Ultrasound is a common imaging technique used to examine pelvic organs, including the uterus, ovaries, and fallopian tubes. It can help identify any uterine abnormalities, such as fibroids (non-cancerous growths in the uterus) or cysts (fluid-filled sacs), that may impact fertility or reproductive health. Ultrasound is a valuable tool in assessing the reproductive system and can provide important information for diagnosing and managing fertility-related conditions.
- Hysteroscopy is when a thin, lighted hysteroscope (tube) is inserted into the uterine cavity through the cervix. It allows doctors to diagnose and evaluate potential uterine issues, such as polyps, fibroids, adhesions, or other abnormalities that may affect a woman’s ability to conceive or carry a pregnancy. Hysteroscopy provides valuable information about uterine health and can help determine the appropriate treatment or management for fertility-related concerns.
- Hysterosalpingogram (HSG) – an x-ray procedure that involves injecting a contrast dye into the uterus to visualize the uterine cavity and the fallopian tubes. The dye helps outline the shape and structure of the uterus and can reveal any potential obstructions or abnormalities in the fallopian tubes, providing valuable information for diagnosing fertility issues.
- Sono hysterogram – an ultrasound scan is done once the uterus is filled with saline and shows the inside of the uterus, the outer surface of the uterus, and obstructions to the fallopian tubes. A sonohysterography may be more specific and accurate in evaluating the uterine cavity than an HSG.
- MRI (Magnetic Resonance Imaging) – a magnetic field and radio waves are used to create a detailed image of the uterus.
Determining the right time to embark on another conception journey is a profoundly personal decision. It’s a moment when you feel emotionally and mentally prepared to embrace any outcome, be it not getting pregnant, experiencing another miscarriage, or achieving a successful full-term pregnancy. Remember that the odds are in your favor, and with hope and resilience, most journeys ultimately lead to positive outcomes.
Author: Karen Synesiou, Infertility Portal, Inc.
