No woman who is trying to get pregnant for the first time dwells on the thought of a miscarriage. There is joy, excitement and nervousness, but there is not the fear of a lost baby, at least not right away. But once you have a miscarriage, every pregnancy that (hopefully) follows will be tainted and will never feel completely safe or secure. And you’ll always wonder, “Could I have prevented this miscarriage?”
Consider the positive: You got pregnant. For many couples, fertility and the ability to conceive is the biggest challenge. Statistics say that after one miscarriage it is likely that you will go on to have a healthy pregnancy the next time. That doesn’t make any woman feel better in the moment, however.
“Most miscarriages are due to a random mistake that occurred in the genes of the sperm or egg or early embryo when they were forming. In these cases, there really isn't anything currently available to prevent them. The woman and couple should realize they didn't do anything wrong that caused the miscarriage and there was nothing they could have done to prevent it,” says Zev Williams, MD, PhD, director of the Program for Early and Recurrent Pregnancy Loss at Montefiore Medical Center.
Besides chromosomal abnormalities, miscarriages can also be caused by structural problems in the uterus, immunologic disorders, thyroid problems, polycystic ovary syndrome (PCOS), blood clotting disorders or hormonal disorders. “In these cases, there are specific treatments that can help,” says Williams. If you are aware of any underlying medical or genetic problems which could predispose you to miscarrying, consult a doctor to find out what can be corrected or managed before you attempt to get pregnant. Alas, many of these physical problems aren’t diagnosed until after a pregnancy is already lost.
Human reproduction is classified as “terribly inefficient” by Sejal Dharia Patel, M.D., a reproductive endocrinologist at the Center for Reproductive Medicine. “The journey of the egg, fertilization and everything that has to go right for implantation means that even the most fertile couples only have a 20-25 percent chance of conceiving in any given month.” It’s a fact that can shake anyone’s confidence about trying to conceive again.
There are basic tenets to uphold to encourage conception and maintain a healthy pregnancy. “Make sure you are neither overweight (BMI over 35) nor underweight (BMI under 19) when trying to conceive,” says Patel, adding that women who are underweight can expect it to take four times longer to conceive.
Don’t smoke — and don’t let your partner smoke. “Smoking for either the man or woman can increase the chances of infertility by 60 percent. The active ingredient in tobacco significantly impacts sperm’s ability to move forward, which is essential for conception,” says Patel. Likewise, limit alcohol and caffeine, drinking no more than two alcoholic drinks per week when trying to conceive and checking the caffeine content of your favorite beverages, Patel adds. “Consuming more than 250mg of caffeine per day can increase the chances of infertility, including miscarriage, by 60 percent.”
Holistically, “The keys to preconception planning are evaluating your diet and assessing for nutritional deficiencies,” says Dr. Tasneem Bhatia, the medical director and founder of The Atlanta Center for Holistic and Integrative Medicine. “Certain key deficiencies will affect hormone balance, fertility status and energy. Diets need to be individualized to the patient. Food intolerances can affect nutritional status and hormones. Stress management and lifestyle inventories are important as well.”
If you live in fear of a miscarriage, over-exercising, overworking and over-stressing can all make you that much more worried about the state of your pregnancy. Talk to your ob-gyn about what things you personally might need to avoid, reduce or improve in order to conceive and keep your pregnancy.
One miscarriage is heartbreaking enough, a second — or more — is enough to make any woman stop and ask herself, “Am I really meant to be a mother?” And that, in and of itself, is tragic. There is help to be had.
“If someone has a history of two or more miscarriages in the first trimester, or any pregnancy loss in the second or third trimester, she should be evaluated by a reproductive endocrinologist and/or a maternal fetal medicine specialist for recurrent pregnancy loss,” says Serena H. Chen, MD, FACOG at the Institute for Reproductive Medicine and Science at Saint Barnabas.
There is also the matter of secondary infertility, when a woman conceived naturally and carried a pregnancy to full-term and then has trouble conceiving or keeping a pregnancy again after giving birth. “Everyone is older for her second baby attempt. Age alone can increase the risks for infertility, miscarriage and sometimes medical problems,” says Chen. “Thyroid dysfunction is a very common disorder that can profoundly affect your fertility and increase your risk for miscarriage. It becomes more common as you get older. Yet, it is very easy to test and treat.”
Don’t be reluctant to seek out fertility treatment or advocate for yourself simply because it seems like you “should” be able to get pregnant and have another child since you already did it once, especially if you have experienced a miscarriage. “I see some women feeling guilty that they are being too ‘greedy’ but secondary infertility can be stressful and deserves a full evaluation,” advises Chen. “Many women with secondary infertility may have real medical issues that need to be corrected. Sometimes the problems can be caused by the first pregnancy. If someone is concerned, they deserve a conversation and consideration by their doctor.”
The sad thing is, miscarriage is very common. When a celebrity reveals her own miscarriage or fertility struggles, the conversation is reignited, and that’s a good thing. A miscarriage can be a traumatic event, affecting some people similarly to any other death of a loved one. Speak with your doctor about your concerns, fears and sadness and request testing. Consider counseling as well to help you cope with your grief and move into the future with strength and hope.
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