Sunday, May 9, 2010

Husband In Oman Concerned With Wife's First Miscarriage: Should She Have A D&C? When Should We TTC Again?


Good Day! My wife is 25, we have been trying to conceive from last three years. She got pregnant as well last march, we have gone for the checkup at 6th week and could see the heartbeat at 90bpm and was asked to have a follow up after two weeks. When we were for checkup we found it as a missed carriage (sp. miscarriage) due to no cardiac activity and eventually we have to go for the D&C procedure.

Now my concern is that, how far and the success rate /time to get pregnant after a D&C procedure? Since we have been trying so hard to get one and finally got disappointed, we are very eager to get the next soon...Please reply me, K. from Oman.

Hello K. from Oman,

The good news is that your wife got pregnant! That tells you that your body can do all the steps necessary to achieve pregnancy naturally. That is a big step because most people with infertility don't know what is going wrong. This also means that she should be able to get pregnant again.

My recommendation is NOT to do a D & C, wait up to four weeks to see if your wife will miscarry naturally and if she doesn't ask for a "medical miscarriage". This is where we use a combination of medications to induce the miscarriage. There is always the danger that an over-vigorous D&C could lead to scar tissue formation called "Asherman's syndrome." Of course, if a "medical miscarriage" is not available where you are, then the only option is a D & C.

Once the miscarriage occurs or D & C, then your doctor should follow the blood pregnancy hormone levels until they go down to "0". At that point, it will take 4-6 weeks for your wife to have another period. Once she has this, you can begin trying for pregnancy again. There is no need to wait any longer than the start of your wife's period, which an indication that her ovaries have begun functioning again.

Good Luck,

Edward J. Ramirez, M.D., FACOG
Executive Medical Director
The Fertility and Gynecology Center
Monterey Bay IVF Program
Monterey, California, U.S.A.

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