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

Question:

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.

Answer:

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

http://www.montereybayivf.com/

Monterey, California, U.S.A.

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.