What The Science Really Says About Pregnancy After a Miscarriage

Getting pregnant can be difficult. And the same goes for staying pregnant, considering the fact…

What The Science Really Says About Pregnancy After a Miscarriage

Getting pregnant can be difficult. And the same goes for staying pregnant, considering the fact that nearly 25 percent of pregnancies end in miscarriage. Enduring a loss of pregnancy is often painful, but as much as healing takes time, men and women may not want to wait too long before they try again. Getting pregnant after a miscarriage, contrary to commonly-held beliefs and even many official recommendations, can have a high chance of success. Specifically, couples who try to conceive within three months of a miscarriage may be more likely to become pregnant and have a healthy pregnancy than those who wait longer.

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The National Institute of Health has found that patients who had their pregnancy after a miscarriage had a higher live birth rate than those who waited longer — 53 percent compared to 36 percent. Additional research from the NIH found that women who got pregnant again within three months of a miscarriage reduced their risk of another pregnancy loss compared to women who conceived after three months. 

In general, the risk of having a second miscarriage is low. Only about 1 percent of women have repeated miscarriages. But “if a woman decides to wait to attempt conception, the miscarriage risk is slightly higher,” says Dr. Mark Trolice, an OB/GYN and reproductive endocrinologist.

This thinking goes against recommendations from very big organizations. The World Health Organization, for one, recommends couples wait up to six months before trying again. The reasoning here is mostly psychological. It is fair to say that extreme emotional distress is not healthy for pregnant women or their developing babies. Bereavement during pregnancy has been linked with an increased risk of stillbirth and depression during pregnancy is associated with a greater risk of sleep and mental health problems for their children later in life. But it is also fair to say that extreme emotional distress does not accurately characterize every person’s experience with miscarriage. 

Trolice puts it more bluntly: “This recommendation was not based on solid medical evidence.” In fact, it was based off only one large study in Latin and South America. In contrast, a 2017 review of studies that included more than 1 million women found that conceiving within six months after a miscarriage led to a lower risk of another miscarriage and of preterm birth.

Exactly why it’s advantageous to try within several months is not settled science. Trolice suspects that couples who conceive right away might be more likely to make the health and lifestyle adjustments needed for a healthy pregnancy. For instance, women who waited longer to get pregnant after a miscarriage had higher rates of obesity compared to women who tried to get pregnant right away. 

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Another possibility: Women who tried to get pregnant within three months may have had more luck, for the simple and unflattering fact that prospective parents are not getting any younger. As more and more couples opt to have children later in life, advancing maternal age has put many women at an increased risk of miscarriage, and advancing paternal age comes with risks for the fetus well. Given men’s and women’s ticking biological clocks, it makes sense that waiting to try after a miscarriage.

“A woman’s peak fertility is actually in her mid-to-late twenties and begins to decline more rapidly after the age of 35,” says Dr. Tom Molinaro, a reproductive endocrinologist at the Reproductive Medicine Associates of New Jersey. “Because of this, a couple should begin trying to conceive as soon as they are ready.”

Every pregnancy is different and so is every miscarriage, so there are many limitations to consider with this data. If the miscarriage involved any medical procedure, it is crucial to take advice from a doctor about when to hold off in order to avoid complications and infections. For couples who have had recurrent miscarriages or experienced a miscarriage after 13 weeks (most miscarriages occur before), there are caveats about trying sooner than later that could pose a health threat to women and their babies, and it is important to discuss these with medical professionals.

The American College of Obstetricians and Gynecologists says there is usually no reason to wait before trying to conceive again. In most cases, ovulation doesn’t pick up again until two weeks after a miscarriage. And most women shouldn’t have sex until two weeks afterwards, according to the Mayo Clinic. That’s the earliest most couples could start trying again. If you’re ready that quickly, there may be a benefit for trying right away: Fertility may actually be higher than usual in the first cycle following a miscarriage, according to one study from 2003.

Both Molinaro and Trolice agree that there is no one-size-fits-all prescription for trying their hands at pregnancy after a miscarriage. However, if couples are physically and psychologically ready to get back on the baby-making horse, there is no need to wait six months to start trying. On the other hand, there is no need to minimize the loss or rush the grief process either. 

“The impact of miscarriage on the couple is often akin to a death in the family. A grieving process is important to ensure full emotional recovery,” Trolice says. “If the couple feels they have healed emotionally and the woman has recovered physically, then they can attempt conception within three months following a pregnancy loss — with reassuring evidence of no increase in miscarriage and probably a higher live birth rate.” 

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