A miscarriage is defined as a gestational loss before the 20th week of pregnancy. This loss is often associated with a grieving process and this sadness can make us question whether we will be able to become pregnant again. Depending on the type of miscarriage, it may have more or less impact on the woman’s future fertility.

Unfortunately, miscarriages are common in the first weeks of pregnancy. Most of them are caused by genetic or chromosomal problems that compromise the correct development of the embryo. That is why the older the woman is, the oocyte quality is the poorer and, therefore, the risk of miscarriage is increased.

The earlier the miscarriage occurs, the less impact it will have in the future. Miscarriages in the first few weeks are naturally evacuated with a haemorrhage with clots. However, if fetal loss occurs later in gestation, curettage, surgical procedure to scrape the walls of the uterus to remove any embryonic debris, may be necessary. This scraping, if not performed correctly, can affect the lining of the uterus and complicate the woman’s future fertility.

When a woman suffers 3 or more miscarriages in a row, it is called Recurrent Miscarriage or Recurrent Pregnancy Loss. This could indicate possible genetic abnormalities, immunological factors or uterine malformations that could impair fertility and reduce the chances of achieving a full-term pregnancy if not treated properly.

Since most miscarriages do not affect fertility, the waiting time for trying to get pregnant again depends mainly on the woman’s emotional recovery after the miscarriage.

On a physiological level, although the WHO recommends waiting up to 6 months to try to conceive again, many doctors recommend waiting only a couple of cycles to check that the uterus is functioning properly, and the endometrium is forming properly to be able to accept an embryo again

Psychological support from friends and family is important. Counselors are available: Your OB or fertility clinic can give recommendations. Support is available from others with experience of infertility or pregnancy loss in online communities. Medically, see a Fertility specialist (Reproductive Endocrinology and Infertility or REI MD) to look for possible causes of miscarriage. Many causes of miscarriage can be treated to reduce the chances of another pregnancy loss in your next pregnancy

Recurrent pregnancy loss is defined as three or more miscarriages in a row. Low dose ‘baby’ aspirin – 81mg a day plus heparin or enoxaparin shots may be needed for antiphospholipid antibodies or blood clotting disorders. Surgery is indicated for a uterine septum (a dividing wall inside the uterus) or for polyps or fibroids affecting the cavity of the uterus. We treat any thyroid or prolactin hormone issues. IVF may be needed for women with significantly diminished ovarian reserve. Pre-Implantation Genetic Diagnosis may be offered and is a good idea if either partner carries a chromosome translocation where part of a person’s DNA is switched between two chromosomes. See a Reproductive Endocrinology and Infertility (REI) specialist.

There are many possible ‘risk factors’ for miscarriage but some women have no risk factors that can be identified ahead of time. Prior miscarriage(s), extremes of female age – early teens or 35 or over, smoking, uncontrolled diabetes or thyroid disease, a personal or family history of blood clots, or autoimmune diseases like lupus may all increase the risk of miscarriage. At least one previous child decreases the risk.

Many possible causes of miscarriage exist. You have more chance of another success than multiple miscarriages with no child. With 2 or more miscarriages we look for low egg supply (diminished ovarian reserve), uterine problems like polyps or fibroids or an abnormally shaped uterus, abnormal antibodies in your blood and other immune system problems, blood clotting disorders, or hormonal problems. Rarely, infections may increase the risk of another miscarriage. Genetic tests can be performed on both partners if needed. See a Reproductive Endocrinology and Infertility (REI) specialist for testing and treatment to reduce the chances of another miscarriage.

Sex when pregnant doesn’t increase the risk of miscarriage, but we usually advise women who are bleeding in the early part of pregnancy (a ‘threatened miscarriage’) not to have sex until the bleeding has stopped; if more bleeding follows after sex it just adds to the anxiety of the situation. A woman who’s had two or more miscarriages needs testing to look for a cause, by a Reproductive Endocrinology and Infertility or REI specialist if you’re trying again, or an OB doctor if you’re already pregnant.

You may still have a healthy baby: you’ve been pregnant 4 times already. Abortions rarely cause problems, but any surgical procedures (D&C) may cause scar tissue inside the uterus. After 2 miscarriages you should see a Fertility MD (Reproductive Endocrinology and Infertility or REI) to look for causes of recurrent miscarriage, including problems inside your uterus like polyps or fibroids or an abnormally shaped uterus, blood clotting disorders, immune system problems, or low egg supply (diminished ovarian reserve). Rarely, infections may increase the risk of another miscarriage.