Pregnancy after miscarriage: How miscarriage impacts your fertility
Reviewed by Jenn Conti, MD, MS, MSc,
Written by Rachel Sanoff
last updated: Sep 08, 2020
6 min read
Here's what we'll cover
Here's what we'll cover
Going through a miscarriage can be a very emotional experience — one that might require a lot of healing before thinking through any next steps. “It can be incredibly challenging to go through a miscarriage,” explains Dr. Jenn Conti, OB-GYN and Modern Fertility medical advisor. “Sometimes it can take a while to process and recover from it.” During that time, honest conversations about miscarriage with people you trust can help you sort through your feelings and identify any questions you might have after losing a pregnancy.
One possible question: How does having a miscarriage impact your fertility in the future, and what might it suggest about your ability to conceive? Here, we're breaking down what happens during different types of miscarriages and explaining what you need to know about getting pregnant after experiencing one if that’s your goal.
What’s considered a miscarriage?
Miscarriage is the term used to describe spontaneous pregnancy loss, and 80% of miscarriages occur within the first trimester, according to the American College of Obstetricians and Gynecologists (ACOG).
As isolating as a miscarriage can feel, you’re far from alone if you experience one: Miscarriage occurs in about 10% of all clinically recognized pregnancies, though the number is likely as high as 20% for all pregnancies. The reason for the difference in percentages? According to Dr. Conti, it’s “a combination of stigma — we don’t talk enough about miscarriage — and the fact that many people don’t recognize they were pregnant when they miscarry because they can happen so early on in a pregnancy.”
As for recurrent miscarriages, which is defined by two or more miscarriages, the percentage is much lower: Only 1% of pregnant people have that experience.
What are the different types of miscarriages?
There are several different types of miscarriages, some of which are more common than others. Most of the following types are what are called clinical miscarriages, which happen after a pregnant person is already aware of their pregnancy from an ultrasound, pregnancy test, or missed period (in order of how early in the pregnancy they occur):
Blighted ovum miscarriages account for 50% of all first trimester miscarriages (within the first three months of pregnancy). These miscarriages happen when the yolk sac develops (which provides nutrients and blood cells for an embryo), but the embryo itself does not.
Chemical pregnancies account for 8-33% of all pregnancies, and 18-22% of pregnancies through in-vitro fertilization (IVF). In contrast to the other clinical miscarriages, this type of miscarriage occurs fairly quickly after implantation, often before someone even misses a period or knows they’re pregnant.
A missed miscarriage happens in around 3% of clinical pregnancies. This is when a miscarriage isn’t detected until a medical appointment where, for example, a doctor observes a pregnancy that has either stopped growing or looks abnormal, and the body hasn’t yet expelled it.
Ectopic pregnancies happen in 1-2% of pregnancies. This condition is when a fertilized egg implants outside of the uterus, often in the fallopian tubes. A normal pregnancy will never develop in these conditions, and sometimes the pregnant person must undergo a lifesaving surgical procedure to remove the embryo. Ectopic pregnancy symptoms (vaginal bleeding and pelvic pain) develop in the first three months of pregnancy, which is why your first few doctor appointments during early pregnancy are so important. They can confirm that the pregnancy is growing in a viable location.
Miscarriages in the second trimester happen in 2-3% of pregnancies. Miscarriages later in pregnancy are those that occur between the 14th and 24th weeks of pregnancy.
What are common causes of miscarriages?
Spontaneous pregnancy loss frequently happens without an obvious medical cause:
In some cases, a fertilized egg doesn’t implant into the uterine lining properly or never develops into a fetus, and doctors can’t explain why.
Or, by complete chance, chromosomal abnormalities arise when the egg is fertilized or the embryo starts dividing.
Sometimes, one of the prospective parents may have low sperm or egg quality, abnormal hormone levels, or abnormalities in their uterus that result in pregnancy loss.
Maternal health history can sometimes contribute to miscarriage:
Blocked fallopian tubes caused by past infections or surgical scarring can result in ectopic pregnancies.
Complications related to autoimmune disorders, such as lupus and thyroid disease, and chronic conditions, such as diabetes and high blood pressure, can result in miscarriage.
Polycystic ovary syndrome (PCOS) can potentially increase the risk of miscarriage, but it’s unclear if the cause is the condition itself or ovulation-inducing medications taken by the individual with PCOS.
Maternal age increases miscarriage risk, too:
35-year-olds have a 20% risk of miscarrying if pregnant.
40-year-olds have a 40% risk of miscarrying.
45-year-olds have an 80% risk of miscarrying.
There are a number of other lifestyle and behavioral factors that also contribute to miscarriage:
Smoking and drug use may result in pregnancy loss, as can exposure to toxins or radiation while pregnant.
Common medications, such as ibuprofen (Advil and Motrin) and certain antibiotics (such as Cipro and Levoquin), can also contribute to miscarriage, so be sure to speak with your doctor about medications you’re currently taking or often take.
Do you have to wait a certain amount of time after miscarrying before trying to conceive again?
After a miscarriage, doctors may recommend waiting a certain amount of time before trying to conceive again; this is the only way fertility is impacted in the short term.
“Technically, you can conceive again during your next cycle,” says. Dr. Conti, since you can ovulate as soon as 10 days after the miscarriage process is done. But you should always follow the specific advice of your personal doctor — the safest, most effective length of time to wait will change depending on your circumstances.
In general, an individual who miscarries should not have penetrative sex for two weeks after pregnancy loss to avoid risk of a uterine infection. Some doctors say you should not attempt to conceive for two to three months after a miscarriage in order to let your uterus and endometrial lining fully recover. Dr. Conti explains that many doctors may recommend waiting at least one month so that the date of your next period can be used to help track your pregnancy.A study published in Obstetrics and Gynecology in 2017 found that people who got pregnant less than three months after a miscarriage “had a lower risk of having a subsequent miscarriage than those who waited six months or longer.” Other doctors say that if you just had your first miscarriage, then you only need to wait two weeks before you can try to conceive again.Doctors may have specific recommendations for a patient based on their health history and whether certain outside factors, such as a health condition, may have contributed to the miscarriage. Pregnancy loss can also have profound emotional and psychological effects on someone, so it’s important to take all the time you need to grieve.
Does miscarriage impact fertility in the long run?
When we talk about miscarriage and ongoing fertility issues, it’s important to remember that miscarriage doesn’t cause infertility. The question is whether or not multiple miscarriages may reveal someone’s underlying fertility issues. If you’ve experienced multiple miscarriages, it can be helpful to talk to your doctor about what the cause may be (more on this in the next section).
If you’ve had one miscarriage, there is a 20% risk that you will have another later on. If you’ve had two miscarriages, you have a 28% risk of another. If you’ve had three miscarriages, your risk of another is 43%. Even if you’ve endured numerous miscarriages, you are statistically more likely than not to carry a pregnancy to term.
What’s recurrent pregnancy loss?
If a person has had two or more spontaneous pregnancy losses, that’s called recurrent pregnancy loss, or repeated miscarriages. Only 1% of people with uteruses will experience recurrent pregnancy loss, and in that case, it’s recommended that they see a fertility specialist and undergo tests before trying to conceive again. Doctors may use blood tests, ultrasounds, hormone tests, genetic screening, an endometrial biopsy, or an MRI to find underlying reasons why a person’s body may be unable to carry a pregnancy to term.
For couples experiencing repeated miscarriages, a genetic abnormality called translocation (where one chromosome transfers a piece of itself to another chromosome) may be present in either partner and be contributing to recurrent pregnancy loss. This is asymptomatic for the carrier, but it can result in chromosomal abnormalities in their sperm or eggs — affecting embryo development and ending in miscarriage each time. You can undergo genetic screening to see if there’s a possibility of chromosomal translocation. If you’re diagnosed, you can talk with your doctor about exploring other options for building your family.
Are there any preventive measures for someone who has already had one miscarriage?
Since the cause of miscarriage is not always clear, there's nothing that can directly prevent pregnancy loss from happening. However, you can reduce some of the risk factors.
Before getting pregnant, talk to your doctor about taking a daily prenatal vitamin with folate or folic acid for at least one month before trying to conceive to reduce the risk of early miscarriage and neural tube (brain and spine) defects. While this advice is not specifically related to miscarriages, avoiding alcohol, cigarettes, and limiting caffeine can contribute to a healthier pregnancy overall.
If you’ve experienced pregnancy loss, it’s important to remember that you’re not alone and that there are many, many people who’ve gone through the same thing — and you can always lean on people you trust to talk through what you’re feeling. (Read more about how to discuss your miscarriage at work, how to rely on your community during this trying time, and how to protect your mental health while coping with the aftermath of miscarriage.)
DISCLAIMER
If you have any medical questions or concerns, please talk to your healthcare provider. The articles on Health Guide are underpinned by peer-reviewed research and information drawn from medical societies and governmental agencies. However, they are not a substitute for professional medical advice, diagnosis, or treatment.
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