What to Do If You Can't Get Pregnant After a Miscarriage

If you can't conceive after miscarrying, you may have an underlying issue

Couple sad over pregnancy test
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Once you've decided to try again after a miscarriage, the time it takes until you are pregnant again may feel like forever, even if you end up conceiving very soon. For couples who don't conceive right away, the wait can be unbearable. Still, given that the odds of getting pregnant in any particular month are only about 30 to 40 percent, even when you have sex during your fertile days, it's not necessarily a sign that anything is wrong if it takes a little bit of time to conceive again.

What to Do If You Are Having Trouble Conceiving

If you've been trying to get pregnant for several months without any success, you may want to speak with a fertility specialist or reproductive endocrinologist. Current guidelines recommend speaking with a fertility specialist if: 

  • You're under 35 and have not conceived within a year after having regular intercourse timed to coincide with ovulation
  • You're over 35 and have not conceived within six months with regular intercourse timed to coincide with ovulation
  • You have had two to three consecutive miscarriages and you haven't been tested for the known causes of recurrent miscarriages

You can check in with your doctor sooner if you are not conceiving and have a specific concern, such as if you have irregular menstrual periods. If it also took you a long time to conceive the pregnancy that you miscarried, it may make sense to speak with a fertility specialist sooner rather than later.

There are a number of reasons why you may not be getting pregnant. These include: 

  • Problems with your partner's sperm 
  • A blockage in your fallopian tubes 
  • Endometriosis—a reproductive condition which can cause chronic pain and infertility 
  • A uterine anomaly, such as a bicornuate—or heart-shaped—uterus 
  • Genetic issues related to fertilization
  • Unexplained infertility—infertility without any known causes 

If you cannot get pregnant, a reproductive endocrinologist or gynecologist with knowledge of infertility can help diagnose these issues. 

Treating Infertility With Ovarian Stimulation and IVF 

Typically, the first step in infertility treatment is the stimulation of the ovaries using hormones FSH and chorionic gonadotropin or clomiphene citrate. This procedure is followed by timed insemination. The most notable effect of ovarian stimulation is multiple pregnancies. Specifically, a 2012 study by suggested that 28.6 percent and 9.3 percent of mothers undergoing ovarian stimulation experienced twin and higher-order pregnancies, respectively.

In other words, about 10 percent of women who successfully undergo ovarian stimulation end up having multiple children in one pregnancy. Multifetal gestation can be concerning, and currently, researchers are trying to figure out how to maximize pregnancy rates while minimizing multifetal gestation.

Some women don't respond to ovarian stimulation and are thus candidates for in vitro fertilization (IVF). With IVF, an egg and sperm are joined in a laboratory dish. Then, about three to five days after conception, the fertilized egg is transferred back to the uterus.

As with other forms of assisted reproductive technologies, IVF can also result in multifetal gestations. In an attempt to curb the chance of multifetal gestations, the American Society for Reproductive Medicine revised their recommendations regarding the number embryos that should be transferred to women younger than 35 years old with favorable prognoses. The new recommendations limit the number of embryos transferred to just two embryos.

Sources

  • Getting Pregnant. March of Dimes.
  • Macklon, N.S., J.P.M. Geraedts and B.C.J.M. Fauser. "Conception to ongoing pregnancy: the 'black box' of early pregnancy loss." Human Reproduction Update, Vol.8, No.4 pp.333-343, 2002.
  • Cunningham F, Leveno KJ, Bloom SL, Spong CY, Dashe JS, Hoffman BL, Casey BM, Sheffield JS. Multifetal Pregnancy. In: Cunningham F, Leveno KJ, Bloom SL, Spong CY, Dashe JS, Hoffman BL, Casey BM, Sheffield JS. eds. Williams Obstetrics, Twenty-Fourth Edition. New York, NY: McGraw-Hill; 2013.

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