D and C or not for miscarriage.

Question:

I wrote to you several months back and took your advice on seeing a fertility specialist since I was approaching and now am 41 years of age (as of late July 2009). In mid-July I went through the pre-testing treatment, including the estrodiol day 3 levels and hsg to check for fallopian tube blockage. My estrodial was 9.6, which was ok, and my tubes were not blocked, per my doctor's review of the testing results. Well, found out that I did get pregnant just after the hsg test, and today at 8 weeks pregnant found out by ultrasound that there is no fetal heartbeat/viable pregnancy. Not sure what to do. It looks like the development stopped around week 6, and at 8 weeks my body has not registered the loss. Should I go for a DNC in a week or so or wait for a natural miscarriage. I would like to do what is best for trying to conceive as soon as possible again. Does a DNC cause extra recovery period than a natural miscarriage? I had a DNC about 3 years ago and it took me about 6 cycles to conceive at the age of 38 (which I had a beautiful girl). Now at 41 there seems to be less time, so any advice would be very appreciated. My ob/gyn told me to come to her office in a week to discuss my options - especially if I have not naturally started to miscarry in a week. Should I head back to the fertility specialist after this time and start treatment? Ultimately my question is whether a DNC has a longer recovery than a natural miscarriage? Thanks, Kim

Answer:

Hello Kim from the U.S.,
　
At this point you have three options:
　
1. Await natural miscarriage.
PROS: It is the most natural method.
CONS: It could take up to 4 weeks, it will be painful and lots of bleeding, it is unpredictable, and you may still need a D&C if all the tissue does not pass.
　
2. Medical induction of miscarriage (vaginal tablets)
PROS: Onset of miscarriage is within 24 hours, easy to use medication
CONS: Just like natural miscarriages except no waiting.
　
3. D&C (Dilation and Curettage)
PROS: Over quickly, scheduled procedure, done under anesthesia so you won't feel anything
CONS: Surgical procedure with surgical risks (infection, perforation, bleeding, anesthesia)
　
With all miscarriages, it will take time for the ovaries to reset so that you can get pregnant. This will take 6-8 weeks. Because of the inflammation caused by the D&C, you need to wait at least 6 weeks.
　
Because of your age, you are at increased risk of miscarriages due to spontaneous chromosomal abnormalities, and, yes, you time is running short. You might want to consider a more aggressive treatment method such as IVF, rather than the natural methods you are using now. IVf increases your chances of a successful pregnancy better than any other method. Otherwise, be prepared for more miscarriages before you are finally successful. Your infertility specialist should have explained exactly what your chances for pregnancy are with each method. If not, then ask.
　
I hope this helps,
　
Edward J. Ramirez, M.D., FACOG
Executive Medical Director
The Fertility and Gynecology Center
Monterey Bay IVF Program
www.montereybayivf.com
　
Monterey, California, U.S.A.

for additional information check out my blog at http://womenshealthandfertility.blogspot.com check me out on facebook and twitter with me at @montereybayivf.