Thankfully, 85% of women who’ve experienced one miscarriage will go on to have a successful pregnancy the next time, as will 75% of women who’ve had two or three miscarriages. 

In this article, we’ll talk about a type of miscarriage that can happen very early in pregnancy, often called a chemical pregnancy, and what to know about trying to conceive after one.

What is a chemical pregnancy

A chemical pregnancy, also called a biochemical pregnancy or biochemical loss, is a pregnancy that results in early miscarriage, shortly after implantation. This type of loss accounts for up to 33% of all pregnancies and 18-22% of IVF pregnancies. And because it happens so early in pregnancy, many people may not even know that they have conceived when they realize there’s a problem. Bleeding from a chemical pregnancy often occurs around the time of an expected menstrual period. 

Signs of a chemical pregnancy include:

• Mild abdominal cramping
• A positive pregnancy test that quickly turns negative
• Vaginal bleeding after a positive pregnancy test
• Low hCG levels on a pregnancy blood test

Many times, chemical pregnancies and early miscarriages are caused by chromosomal abnormalities in the embryo. Many of these abnormalities occur randomly as the embryo divides and grows. It’s estimated that problems with the baby’s chromosomes are responsible for 50% of early pregnancy loss. Being 35 or older, having untreated blood clotting or thyroid disorders, and other medical conditions like uncontrolled diabetes, can increase risk as well.

It can be heartbreaking to receive a positive pregnancy test and then experience a loss so quickly afterwards. Give yourself time to heal both physically and emotionally before trying to conceive again. Some people may find talking to others who’ve had early miscarriages helps and makes them feel less alone. Others may not be ready to talk about it and that’s ok too.

Trying to conceive after a chemical pregnancy

Generally it’s a good idea to wait at least 2 weeks after a chemical pregnancy to have vaginal intercourse again to prevent the risk of infection. There is typically no treatment needed, so once you’ve waited the two weeks, given yourself some time to heal, and you feel ready to start trying to conceive again, you should be able to. That said, it’s always a good idea to talk to your provider if you have questions. 

If you decide you don’t want to start trying to conceive right away, keep in mind you can still ovulate 2 weeks after the chemical pregnancy, so you may want to have a birth control method in place. Talk to your healthcare provider for guidance on when to start trying to conceive again.

If you’ve only had one chemical pregnancy and no previous issues with fertility or trouble getting pregnant, it’s usually not necessary to see a specialist at this point. However, you may want to consider seeing a specialist in certain scenarios, such as if you:

• Are over age 35
• Have had 2 or more miscarriages
• Have experienced fertility problems
• Have an illness that could affect your pregnancy (e.g. high blood pressure or diabetes)

Because a chemical pregnancy happens so early on, some people may find they move on rather quickly, while others may take longer to recover. There is no right or wrong way to grieve a pregnancy loss. Just know that your chances of having a subsequent successful pregnancy are high, about 80% after one miscarriage. And you can always reach out to your healthcare provider for guidance and support.

Reviewed by the Ovia Health Clinical Team

Sources

“Signs of miscarriage.” American Pregnancy. American Pregnancy Association. n.d. https://americanpregnancy.org/healthy-pregnancy/pregnancy-complications/signs-of-miscarriage/.

“Chemical pregnancy.” Miscarriage Association. Miscarriage Association. n.d. https://www.miscarriageassociation.org.uk/information/miscarriage/chemical-pregnancy/.

Mayo Clinic Staff. “Pregnancy after miscarriage: What you need to know.” Mayo Clinic. Mayo Clinic. March 12, 2019. https://www.mayoclinic.org/healthy-lifestyle/getting-pregnant/in-depth/pregnancy-after-miscarriage/art-20044134.

“Pregnancy after miscarriage.” American Pregnancy. American Pregnancy Association. n.d. https://americanpregnancy.org/getting-pregnant/pregnancy-loss/pregnancy-after-miscarriage/.

Here’s the latest from the Ovia Health Clinical Team, including answers to your questions and some practical guidance. 

If I’m pregnant and I get COVID-19, will the infection be worse?

It’s possible. Research indicates that pregnant people and recently pregnant people (within 42 days of giving birth) are at higher risk for significant complications from COVID-19 than their non-pregnant peers. This means that while the overall risk for severe illness is low, there is an increased risk of hospitalization, intubation and mechanical ventilation, blood clots, and requiring intensive care. There is also an increased risk of adverse pregnancy outcomes, including preterm birth and possibly an increased risk of pregnancy loss when compared to pregnant women who did not get COVID-19. 

These risks are compounded for Black pregnant people, who have long experienced nearly twice the risk of preterm birth when compared to white people. Many studies have demonstrated that race is likely an independent risk factor when it comes to healthcare outcomes like preterm birth, separate from other risk factors like income or education. That race-related risk may stem from chronic stresses of societal racism as well as the race-related inequalities that have been identified within the healthcare system. 

Pregnant parents who test positive for COVID-19 should be offered a discussion about the medication Paxlovid. You can read more about that here.

What can I do to prevent infection?

Prevention is no different for pregnant people than it is for anyone else. Follow the advice that you receive from your local health department, from the CDC, and from your healthcare provider. Avoid going to public places if you think or know you have COVID-19, to prevent spreading it to others. 

If you know local rates of Covid are high, wear masks when indoors and practice social distancing. Being vaccinated has been shown to provide protection against severe COVID-19 disease. However, you can still get sick and pass the illness on to vulnerable people who aren’t vaccinated or cannot be vaccinated (like newborns).

Is hand sanitizer safe in pregnancy?

Yes, Yes, YES. The CDC reports [3] that handwashing with soap and water is more effective than hand sanitizer. However, you can’t take the sink in your car or on a walk or to the grocery, so make sure you use hand sanitizer regularly in addition to handwashing. Furthermore, it’s often much easier to wipe hand sanitizer on your children’s hands than it is to get them properly washed, so consider this a regular habit as well.

If I get COVID-19, will I pass it to my fetus?

The most recent research on the topic says that transmitting COVID-19 while pregnant is very rare – for moms in North America, the rate was about 0.1%. This does not include the risk of passing it to your newborn during routine care postpartum. However, studies suggest that people who tested positive for COVID-19 during pregnancy are more likely to have complications, such as preterm birth [6]. There is no evidence that cesarean delivery reduces the risk of infection for Baby, so this is not recommended.

What about during and after birth?

It is extremely important that you call your healthcare provider before you go to the hospital if you think you have COVID-19. Once at the hospital, your provider knows what to do to reduce the risk that your baby (and the healthcare professionals who care for you) will become infected.

Keep in mind that testing positive for COVID-19 when in labor may cause changes to your birth plan and hospital stay. You may want to consider extra precautions in the last weeks of pregnancy to avoid this.

What is the risk to my baby? And what about the risk to my other children?

Children seem to be at less risk of becoming really sick with COVID-19 than adults are, but infants make up the bulk of serious cases and hospitalizations in children under 17. Current evidence suggests that babies are not likely to get COVID-19 from their mothers as long as preventative steps are taken, such as wearing a mask around your baby, washing your hands for 20 seconds prior to holding your baby, and having them sleep 6 feet away from you. You should still do everything you can to reduce the risk of exposure. Children with certain underlying conditions are at risk for complications from COVID-19, so it is important to keep them safe and communicate with their pediatrician.

Is breastfeeding safe if I think I have COVID-19?

There are many benefits to breastfeeding for parents and babies. It appears unlikely that COVID-19 can be transmitted through breast milk, though helpful antibodies can be passed along! 

If you test positive for COVID-19, this may impact the care of your newborn. In-hospital, the CDC recommends discussing with your provider the risks and benefits of caring for your newborn while sick. Mildly ill people generally room in and care for their newborns. If you are seriously ill, this may not feel like a physically possible or safe option. Once you are home, wash your hands frequently — and always before touching your baby. Wear a mask when you are within 6 feet of your baby or another person. If you have a caregiver who lives with you, they should also wear a mask whenever caring for your baby.

We know that with other illnesses, you pass antibodies to your baby through your breast milk. Antibodies are what your body makes to help fight off illness. The research into COVID antibodies in breastmilk is really encouraging and suggests that antibodies are passed through breast milk after infection or vaccination. 

What if I’m trying to conceive and not yet pregnant?

There’s no evidence that COVID-19 or any similar viruses impact conception or cause birth defects if you are sick when you conceive.

Should pregnant people get the COVID-19 vaccine?

Multiple well-respected clinical organizations, including the ACOG (the American College of Obstetricians and Gynecologists) and the ACNM (American College of Nurse-Midwives), recommend the vaccine to people who are trying to conceive, pregnant, and breastfeeding [11].

The first clinical trials for the COVID-19 vaccines manufactured by Pfizer-BioNTech, Moderna, and Novavax did not include participants who were known to be pregnant or breastfeeding. This is typical for pharmaceutical research. Recent studies have included pregnant people and show that there is no increased risk and that vaccines given in any trimester do not negatively impact pregnancy outcomes. In addition, vaccinating in the second or third trimester may offer additional protection to your newborn.

Additionally, none of these COVID-19 vaccines contain a “live” virus. This means you cannot get COVID-19 from the vaccines. In general, vaccines that do not contain “live” viruses are safe during pregnancy and do not have increased risks for infertility, miscarriage, fetal anomalies, or stillbirth. Side effects of the COVID-19 vaccines include pain at the site of injection, fever, fatigue, and chills. These typically go away after a couple of days. These side effects are normal and expected and are indicators of your immune system doing its job to learn to protect you from the virus. There have been very rare reports of unexpected, adverse reactions from the vaccines. A severe allergic reaction called anaphylaxis can happen in very rare cases. The incidences of these adverse events are so low that getting vaccinated remains safer than potentially getting infected with COVID-19. [12].

You can also reach out to the experts at Mother to Baby for more information. Your midwife, doctor, or other healthcare professional is also a great resource for more information about the COVID-19 vaccine. Ultimately, you are the one who knows what is best for your body and your family.

Reviewed by the Ovia Health Clinical Team

Sources:

Dara D. Mendez, Vijaya K. Hogan & Jennifer F. Culhane “Institutional racism, neighborhood factors, stress, and preterm birth”. Ethnicity & Health. 19:5, 479-499. October 18, 2013.

Jasmine D. Johnson et al., “Racial Disparities in Prematurity Persist Among Women of High Socioeconomic Status,” American Journal of Obstetrics & Gynecology 2. 2(3), 100104. Nov 10, 2020

James W. Collins Jr et al., “Very Low Birthweight in African American Infants: The Role of Maternal Exposure to Interpersonal Racial Discrimination,” American Journal of Public Health. 94(12), 2132–2138. December 2004.

Braveman Paula, et al. “Explaining the Black-White Disparity in Preterm Birth: A Consensus Statement From a Multi-Disciplinary Scientific Work Group Convened by the March of Dimes” Frontiers in Reproductive Health. Vol. 3. 684207 September 2, 2021.

The differences between an IVF and an ICSI

Articles and websites are known to use the two names (IVF and ICSI) interchangeably, without explanation, or definition. How are people supposed to know what these treatments are and how they’re different? Wait, are they different? Let’s start from the beginning.

In Vitro Fertilization (IVF)

You may already know a little about IVF because it’s probably the most popular form of assisted reproductive technology (ART) out there. It’s also the most expensive. One IVF cycle can cost anywhere from $8,000 to $30,000 depending on factors like age, health, or if you plan on using donor sperm or eggs. However, if IVF turns out to be the right choice for you, it may very well be worth the hefty price tag.

Many people who seek out IVF treatment do so because they have issues with fertility. These could include endometriosis, polycystic ovary syndrome (PCOS), problems with sperm function, and unexplained infertility. For people over 35, IVF may also offer a better chance of conceiving than traditional intercourse, ICI, or IUI. It’s always a good idea to speak to your healthcare provider when you are thinking about moving forward with any ART or other fertility treatments.

How IVF works

The IVF process can take up to two weeks, and there are several different ways to prepare the body for treatment based on individual health. These preparations include taking hormone-encouraging drugs to boost ovulation and improve chances of producing a high number of mature eggs. There are also medications to help prepare the uterine lining for fertilized embryos. Specialists work closely with patients to help develop a game plan.

When a healthcare provider gives the green light, mature eggs will be carefully retrieved from the ovaries. These eggs (or donor eggs) are taken to a lab where they will then be put in a petri dish with fresh sperm (collected shortly before the procedure), or sperm that has been thawed and prepared beforehand. These close living quarters will allow sperm to mingle with eggs in a way that is isn’t really possible during traditional intercourse. Aside from the setting of the petri dish, the fertilization process is much the same as during intercourse. In the end, one sperm should match up with one egg. Then it’s a bit of a waiting game. If the procedure is successful, after a period of two to six days, the fertilized embryo or embryos will finally be transferred to the uterus, where, hopefully, implantation will be successful and result in pregnancy! With IVF and ICSI, it’s sometimes possible to find out if it worked by taking a pregnancy test as soon as two weeks after implantation.

Intracytoplasmic sperm injection (ICSI)

This treatment is also used when people are having trouble getting pregnant, or by people using donor eggs or sperm. The name “intracytoplasmic sperm injection” makes ICSI sound like a very complicated treatment, but when you break it down, the concept is pretty straightforward. In truth, the term is just a really formal way of saying that during the ICSI process, sperm will be directly injected into an egg to fertilize it. But, what exactly does that mean, and how is it possible?

How ICSI works

ICSI is a form of IVF treatment, often referred to as “IVF with ICSI,” so both processes take place in a IVF lab. As for preparation, traditional IVF and ICSI are very similar, if not identical in some cases. The real difference between the two happens after the sperm and eggs have already been taken to the lab. Unlike traditional IVF, ICSI samples are not mixed together in a petri dish and left to match up on their own. Through the ICSI process, you are able to make the connection for them. A single egg is delicately held in a specialized pipette, while a very small and hollow needle carefully selects a single sperm and immobilizes it by picking it up. Once both parties are secured, the needle is slowly brought through the shell of the egg (zona) before reaching its goal at the center of the egg (cytoplasm). The needle then places the sperm within the cytoplasm. After injecting the sperm, the process is complete, and the needle is removed. Eggs are checked after a day or so to see if the process of “normal fertilization” has begun. Just like traditional IVF, the successfully fertilized eggs are then implanted in the uterine lining once they are mature enough.

Other things to consider

In the end, there really isn’t a “qualifying factor” that can say for sure whether you should use traditional IVF or ICSI treatment (though ICSI may be more effective in cases of severely low sperm count and unexplained male infertility). The process of egg retrieval and insertion of embryos into the uterus are the same between both options. Both are mostly painless, and have mild side effects. In fact, because ICSI has become more popular over the last decade with a 70% to 85% fertilization rate, many clinics have begun to use the two procedures interchangeably, and some have even begun using ICSI for every treatment!

We all know that it’s sometimes difficult to get a straight answer from the internet. We’ve covered the basics, but nothing can replace your healthcare provider’s knowledge and advice. Asking them detailed questions may be the first step in beginning your IVF journey!

Read more

• Sperm donation 101
• Egg donation: thinking it through

Sources

• Mayo Clinic Staff. “In Vitro Fertilization (IVF)”. Mayo Clinic. Mayo Clinic. March 22, 2018. https://www.mayoclinic.org/tests-procedures/in-vitro-fertilization/about/pac-20384716
• “Intracytoplasmic Sperm Injection- ICSI and IVF. Advanced Fertility Center of Chicago. Advanced Fertility Center of Chicago. 2017. https://www.advancedfertility.com/icsi.htm
• “Egg Donation Cost at the Advanced Fertility Center of Chicago”. Advanced Fertility Center of Chicago. Advanced Fertility Center of Chicago. 2017. https://www.advancedfertility.com/eggdonationcost.htm

No period, not pregnant: What does it mean?

The rollercoaster of emotions that come with taking a pregnancy test is often stressful, but don’t give up just yet. Here’s what it means to have no period for a while and still not be pregnant.

Reasons why a test could be wrong

Here are a couple reasons why you may have received a false negative.

• Taken before the first missed period: Pregnancy tests work by detecting levels of human chorionic gonadotropin, hCG, a hormone that the body starts to make when an egg has been fertilized. Because the tests look for the presence of this hormone, it is possible that they miss the hormone in the very early stages of pregnancy, mainly in the days leading up to the first missed period. For the most accurate readings, it’s best to wait until at least the missed period, if not a few days after.
• Fluids diluting urine: Yes, you should still be drinking lots of water! But taking a pregnancy test later in the day can sometimes mean that urine is diluted and hCG is more difficult for the test to detect. The hormone levels are highest in the morning too, so for the most accurate results try to take the test as early in the day as possible, preferably right after you wake up.
• Test directions not followed correctly: We don’t mean to suggest that you would miss a step . . . but could you have missed a step? Some tests require waiting a specific amount of time before reading the results. Pregnancy tests also have an expiration date, so we recommend buying new ones as opposed to using old ones that could be in your house.

Final thoughts

Ultimately, it’s always a good idea to read and closely follow the directions on home pregnancy tests, even if you consider yourself a pro by now. There’s also always the possibility that the negative test is accurate, and your period is simply a few days late. Home pregnancy tests are great, but after a positive result, it’s still important to visit your healthcare provider for a blood test to confirm.

Sources

• “Pregnancy test.” MedlinePlus. US National Library of Medicine, Oct 4 2016. https://medlineplus.gov/ency/article/003432.htm.
• Mayo Clinic Staff. “Home pregnancy tests: Can you trust the results?” MayoClinic. Mayo Foundation for Medical Education and Research, Dec 2015. http://www.mayoclinic.org/healthy-lifestyle/getting-pregnant/in-depth/home-pregnancy-tests/art-20047940.

What happens after a miscarriage?

The process of recovering from a miscarriage can be made even more difficult by the fact that certain experiences aren’t talked about as much as others. Here are five things you might experience after a pregnancy loss, and ways to handle them.

1) Seeing babies or other pregnant women might be really difficult for a while.

After experiencing a pregnancy loss of any kind, it can be difficult for women to see or hear anything related to pregnancy and babies. Things like seeing a baby bump or hearing women talk about their pregnancies might make you feel sad, angry, or might even make you start to cry. This might catch you off-guard, but it’s a completely normal reaction when you take into account the fact that you’ve been through a traumatic experience, and being reminded of babies can make you revisit that trauma.

Consider writing in a journal as a way to get these feelings out. If writing doesn’t appeal to you, find someone who you can talk to who has been through a similar situation, or who understands that these responses are an acceptable and natural part of the grieving process.

2) You and your partner may grieve in different ways.

Two people can react to the same situation in completely opposite ways, and this is especially true for something as intense and devastating as grief. Perhaps your partner needs to talk a lot, and you don’t. Or maybe it’s the opposite and your partner shuts down whenever they are sad. It’s possible that your partner feels as though they need to be strong for you so they push their grief aside completely.

No matter your grieving styles, you’ll be able to get through any pain you’re both feeling by communicating with one another. Ask each other questions. Be sensitive to the answers, and respect each other’s boundaries. Be gentle with yourselves and with one another. Remember that healing will take time for both of you.

3) People might say things that are hurtful or offensive to you.

Grief is an extremely difficult thing for people to deal with, and most people won’t know the right thing to say to you. You might hear things like, “at least you weren’t further along,” “at least you don’t have to buy maternity clothes!” “it was God’s will” or “everything happens for a reason.” Other people may tell you life goes on or that you’ll feel better soon. While they come from a well-intentioned place, these comments can be hurtful and cause you more pain when you least expect it.

No matter what anyone says, you should never feel wrong or foolish for caring as much as you do. Anyone who has been through this kind of experience could tell you that your feelings are entirely appropriate, and there is no wrong way to grieve. You don’t need to listen to or believe people who say things that make you feel bad, or even mildly annoyed. If you find yourself in a conversation with someone who is making you uncomfortable, let them know you appreciate their support but that you would rather talk about something else.

4) You might feel a need to memorialize the loss.

Some women mark their pregnancy loss with a special ritual that helps them celebrate and remember the babies that they loved, and will always love. After all, when our loved ones pass away, we have certain personal and familial traditions that we undergo. But in the United States at least, miscarriages have largely remained private and unceremonialized, which can contribute to women and their partners feeling restless, or like they have to move on faster.

Women who are searching for a way to memorialize their baby may want to look into the Buddhist tradition of mizuko kuyo. This is a ceremony offered by more and more American Zen Centers. Some women might also find comfort in writing letters to their babies, planting plants or trees in honor of their babies, or purchasing customized jewelry to remind them of their babies.

5) You might blame yourself or feel like you are a failure.

Many women feel as though the loss of a pregnancy was somehow their own fault. They may get mad at themselves or their own bodies. They may start to obsess over every little thing they did, ate, or felt – searching for the moment they could have prevented the events that unfolded. But the truth is, miscarriages can happen to anyone. They are more common than anyone talks about. You are not the failure, and you are not to blame.

Sources

• “Miscarriage.” PlannedParenthood. Planned Parenthood Federation of America Inc, 2016. Web.
• OBOS Pregnancy and Birth Contributors. “Miscarriage in the First Trimester.” OurBodiesOurselves. Our Bodies Ourselves, Apr 9 2014. Web.
• “Miscarriage.” MarchofDimes. March of Dimes Foundation, Jul 2012. Web.
• “Pregnancy loss: How to cope.” MayoClinic. Mayo Foundation for Medical Education and Research, Jun 25 2016. Web.
• Elizabeth Leis-Newman. “Miscarriage and loss.” APA. American Psychological Association Monitor on Psychology. 43(6)56. Web. June 2012.

More about missed miscarriages

Missed miscarriages are uncommon, occurring in about one-percent of all pregnancies, but when they happen, they can be devastating.

Why do missed miscarriages happen?

The majority of missed miscarriages occur in the first 12 weeks of pregnancy. This type of pregnancy loss often happens as a result of chromosomal abnormalities with the embryo, for example if the embryo has too many or too few chromosomes. Abnormalities like these make it impossible for the body to continue the pregnancy. In other cases, a missed miscarriage occurs for unknown reasons.

What are the symptoms?

Women who experience a missed miscarriage usually don’t have typical miscarriage symptoms like bleeding or pain. In most cases, the miscarriage goes undetected until a woman’s next appointment. Some women still experience pregnancy symptoms, which can happen if the placenta continues releasing the hormones that cause pregnancy symptoms. Unfortunately, the presence of pregnancy symptoms can make a missed miscarriage diagnosis that much more surprising.

How is a missed miscarriage diagnosed?

Most women discover that they have miscarried at their regular check-up, when the provider notices an underdeveloped embryo or a lack of fetal heartbeat in the ultrasound. To make sure there isn’t a heartbeat, the provider will send the woman to a radiologist for confirmation. The provider will also probably take a blood test to measure hCG levels (the hormone that is produced during pregnancy). If these are low and there’s no heartbeat to be found in the ultrasound, the provider will diagnose a missed miscarriage.

How is a missed miscarriage treated?

With a missed miscarriage, the body still has to expel pregnancy tissue, so after a diagnosis the next step is determining a way to remove this tissue. A provider might recommend any of the following for treatment.

• Wait and let the tissue expel naturally: Women may choose this option if they want to let the pregnancy end on its own, or if they don’t yet want to take medical or surgical action. This is usually not an option after eight or nine weeks, however.
• Medical treatment: Women can take a drug called misoprostol that helps the body expel the tissue. This might be preferable for women who are very early in their pregnancy, or for women who prefer treatment that is less invasive than a D&C.
• Surgical treatment: A provider might recommend a dilation and curettage (D&C) if a missed miscarriage occurs after eight or nine weeks. For this procedure, the woman is put under anesthesia, her cervix is dilated, and the provider uses a thin instrument to remove the pregnancy tissue from the uterus.

What comes after treatment?

Women who have been treated for a missed miscarriage should wait one menstrual cycle before trying again to conceive. It’s entirely likely, though, that women who experience a missed miscarriage will want some time to grieve before trying again. Miscarriages can be devastating, and this kind of miscarriage is made more painful by the fact that it often comes as a complete surprise, and sometimes happens for an unknown reason.

It takes some women a long time to recover from the loss, although the healing process is different for everyone. What is the same for every woman in this situation is that due to the traumatic nature of a missed miscarriage, as well as the hormone changes that take place during and after a miscarriage and make a woman vulnerable to postpartum depression, it’s important for women to find a way to process their feelings or reach out to someone who can support them while they grieve.

Sources

• Linda W. Prine, Honor Macnaughton. “Office Management of Early Pregnancy Loss.” Am Fam Physician. 84(1):75-82. Web. Jul 2011.
• “Miscarriages.” KidsHealth. Nemours Foundation, Jun 2015. Web.

What’s a miscarriage and what to do about it

Common physical symptoms of miscarriage include abdominal cramping, abdominal pain, lower back pain, and vaginal bleeding, which can range from spotting to heavy. Many of these symptoms can occur for other reasons during early pregnancy, so it’s best not to jump to conclusions. However, never hesitate to contact your healthcare provider if you are feeling something that doesn’t feel normal. Being familiar with these symptoms will help you know when you should take the following steps.

Call a provider

A healthcare provider can perform certain tests that confirm whether or not somebody is experiencing a miscarriage. The earlier these results come in, the faster the provider can treat whatever is going on, whether it’s a miscarriage or something else. These tests might include a pelvic exam, a blood test, or an ultrasound.

Ask a friend or family member for a ride

It’s unsafe for anyone to drive if they’ve been bleeding extensively. After the appointment, it also might not be safe to drive oneself home, depending on any procedures or medications performed or prescribed. Having a driver will make the situation much more manageable.

Notice the amount and duration of bleeding or spotting

Being able to describe the amount of vaginal bleeding a woman has experienced could be helpful for the provider to form a diagnosis. Bleeding that increases or stays bright red over time might indicate a problem, so if possible, women should try to notice these details and report them to their provider.

Having a miscarriage (or a miscarriage scare) can be so shocking and stressful that it’s understandable if women can’t remember to do certain things while it’s happening. This is completely understandable, but if possible, it can be beneficial for women to ask their provider if they think she should try to save any fetal tissue during the miscarriage. This might sound surprising, but fetal tissue that comes out with vaginal bleeding can be tested in a lab to help identify if there was a particular cause of the miscarriage. While not all women will be able to differentiate between vaginal bleeding and fetal tissue, if possible, it is helpful to save any of this tissue in a clean container and bring it with you to your appointment.

Think about comfort and cleanliness

Many may need need pads or panty liners to control the bleeding during a miscarriage. Tampons should not be used during a miscarriage, as they increase the risk of infection. They might also want to get bed liners for the bleeding, or a hot water pad for cramps. A provider might prescribe pain medication if the cramping or pressure is intense.

Moving forward after a miscarriage diagnosis

It’s often recommended that women abstain from sexual intercourse for a period of time after a miscarriage, usually anywhere from two to four weeks. When the bleeding stops, blood will be drawn to determine when the levels of pregnancy hormones return to zero. This helps her provider know when the miscarriage is complete.

Once a provider confirms that the miscarriage is safely complete, the healing process can begin. There’s no right or wrong way to grieve; there’s also no set date for when to start feeling better after a pregnancy loss. What’s most important is that she feels safe to grieve however she feels most comfortable, and also, that she has the support of friends, family, and her provider to help her through this difficult time.

Thinking about the possibility of miscarriage is difficult, but pregnant women can benefit from knowing the warning signs of certain situations that may happen during pregnancy. Just like fire drills and CPR training are valuable, knowing what to do during a possible miscarriage helps women get faster treatment if the situation ever arises.

Sources

• OBOS Pregnancy and Birth Contributors. “Miscarriage in the first trimester.” OurBodiesOurselves. Our Bodies Ourselves, Apr 9 2014. Web.
• “Miscarriage.” PlannedParenthood. Planned Parenthood Federation of America, Inc., 2016. Web.
• Mayo Clinic Staff. “Miscarriage: Symptoms and Causes.” MayoClinic. Mayo Foundation for Medical Education and Research, Jul 20 2016. Web.
• Robin Elise Weiss. “I’m having a miscarriage: What to do if you’re having a miscarriage.” VeryWell. About Inc., Jun 8 2016. Web.

What is ectopic pregnancy?

The majority of ectopic pregnancies occur in the fallopian tubes. Early symptoms include vaginal bleeding and lower abdominal pain in the first trimester. They are also dangerous, because if they rupture, the woman risks life-threatening internal bleeding and infection. A diagnosis and treatment can be lifesaving for women with ectopic pregnancies.

Diagnosis

If an ectopic pregnancy is suspected, a woman’s healthcare provider will usually use a combination of methods to make a diagnosis.

• Transvaginal ultrasound: For this test, the provider places a device in a woman’s vagina to get a clear picture of her reproductive organs. This kind of ultrasound is extremely effective for detecting ectopic pregnancy, but it doesn’t always pick up very early ectopic pregnancies. Because of this, sometimes an ultrasound is postponed for a few weeks until the pregnancy is easier to detect.
• Blood test: This helps the provider determine how much hCG (human chorionic gonadotropin, an important pregnancy hormone) is in the woman’s body. If the levels of hCG are lower than normal, this could indicate an ectopic pregnancy.

Treatment

Unfortunately, because ectopic pregnancies are life-threatening due to their risk of rupturing, they do have to be removed as early as it is safe to remove them. A woman’s provider will decide how to treat the ectopic pregnancy after confirming the diagnosis using ultrasound and/or blood tests. Treatment might involve medication or surgery, depending on how early the ectopic pregnancy is diagnosed, risk of rupture, and other considerations.

• Medication: Certain medications stop the growth of an ectopic pregnancy. The most commonly used is methotrexate, which is administered through an injection and helps embryonic tissue exit the body. Methotrexate causes symptoms that are similar to a miscarriage, with the most common symptom being abdominal pain or cramping. Studies haven’t shown a clear time interval that women should wait before trying to conceive again after methotrexate use, but providers may recommend waiting anywhere from three to six months before conceiving, in order to allow the medication to fully leave the body.
• Surgery: A laparotomy is the surgical procedure a healthcare provider might use to remove the developing embryo in an ectopic pregnancy. For the surgery, the provider will make an incision and remove the embryo, as well as repair or remove the fallopian tube if it’s damaged. After surgery, most women experience light vaginal bleeding possibly with some blood clots for at least a few weeks, which is normal. Women will also be instructed on how to keep the incision site clean, and to check for infection.

Future pregnancies

If the ectopic pregnancy is caught early and the fallopian tubes aren’t damaged, it is quite possible for women to have a healthy pregnancy in the future. If the tubes are damaged or removed, however, women may have more difficulty conceiving. If you are having difficulty becoming pregnant again after an ectopic pregnancy, it’s a good idea to meet with a fertility specialist, who can help you determine your next steps.

An ectopic pregnancy diagnosis is often accompanied by feelings of sadness, confusion, and grief. Because women with a history of ectopic pregnancy are at higher risk for ectopic pregnancy in the future, women should talk to their healthcare providers if they are considering pregnancy to make sure that it’s safe for them, both physically and emotionally, to start trying again.

Sources

• “Ectopic Pregnancy.” KidsHealth. The Nemours Foundation, 2016. Web.
• Mayo Clinic Staff. “Ectopic Pregnancy: Tests and Diagnosis.” MayoClinic. Mayo Foundation for Medical Education and Research, Jan 20 2015. Web.
• Karla Blocka and Brian Wu. “Quantitative hCG blood test.” Healthline. Healthline Media, Inc., Oct 8 2015. Web.
• “Ectopic pregnancy: Clinical manifestations and diagnosis.” UptoDate. UpToDate, Inc., Sep 2017. Web. Accessed 10/26/17. Available at https://www.uptodate.com/contents/ectopic-pregnancy-clinical-manifestations-and-diagnosis.

Should you try to conceive again after pregnancy loss?

To determine how ready you are to start trying again, ask yourself some questions about how you’re feeling and what you want. Some of these questions could be:

• How is my emotional health? Could I benefit from counseling?
• Have I talked to my healthcare provider about whether my body is physically ready for another pregnancy?
• Does my partner also want to keep trying?
• Right now, could I handle the emotions associated with trying to conceive (TTC)?
• If your next pregnancy will be considered high risk: Am I well enough right now to handle any stress that could accompany the next pregnancy?

It really is all about you

Once you are medically cleared, there’s no right or wrong time to be ready to TTC after a miscarriage. Every woman is different in how she handles the experience, so it’s up to you to determine if you’re emotionally and physically capable of TTC again. There’s nothing wrong with wanting to wait a little longer, but there’s also nothing wrong with being ready to try again earlier than you first expected.

Research suggests that pregnancy after miscarriage might be healthier if women wait less than a year to conceive again. According to Mayo Clinic, women who got pregnant again within six months of a miscarriage actually had fewer complications in their next pregnancy than did women who waited more than six months to conceive. You might not be ready to try again so soon, and that’s perfectly fine. But if you are ready, and your provider has given the go-ahead, know that it’s safe to do so.

What you’ll need

If you decide that you’re ready to try again, you’ll want to ensure that you’re physically and emotionally prepared for anything that comes your way while TTC. It’s a good idea to have all of the following in place.

• An exam from your healthcare provider: He or she will assess if you’re physically healthy and ready to try for another pregnancy.
• Support from a partner, friends, family, or a support group: You may find yourself needing people who can help you through this experience, whether they’re providing a listening ear or a ride to your provider’s office.
• Healthy lifestyle choices: Most miscarriages can’t be prevented, and a big part of healing involves understanding that the loss was no one’s fault. But taking precautions to reduce the risk of another miscarriage is always a good idea; this means not smoking, limiting caffeine and alcohol intake during pregnancy, maintaining a healthy weight and taking prenatal vitamins while TTC.

Staying positive and hopeful

Most miscarriages are followed by perfectly healthy pregnancies. This being said, many women are still nervous about trying to conceive again after a pregnancy loss. As you consider and possibly move forward to start trying again for a pregnancy, take some time each day to remind yourself of your own strength, and to focus on all the love and support that you have in your life right now.

Sources

• Felicia Nash. “Pregnancy after preterm birth or loss.” HandtoHold. Hand to Hold, 2012. Web.
• “Getting pregnant: When is the best time for a miscarriage?” MayoClinic. Mayo Foundation for Medical Education and Research, Mar 17 2016. Web.
• Chaunie Marie Brusie. “Tips for Conceiving After a Miscarriage.” Parents. Meredith Corporation, 2013. Web.

Miscarriage support options

For women who are struggling after they miscarry, support is crucial to help them while they grieve. There are a few different types of support for women who experience this unique and difficult type of loss.

Partner

Partners struggle with miscarriage, too, and relationships can change as people grieve or struggle differently after an unexpected loss. Talking to a partner after miscarriage is helpful for a relationship, as well as for the healing process. It may be hard to start the conversation at first, but there are a number of online resources that have specialized advice for this.

Friend or family member

Women often find support among friends or family members, especially ones who have prior experiences with miscarriage because they’ll be the most understanding of the situation.

Provider

Women might not be able to stop thinking about their loss, or they might be experiencing mood disturbances, anxiety, or depressive feelings. In these cases, it can be immensely helpful for them to talk to their provider about these feelings. A provider can provide a referral to a psychologist or psychiatrist for further help.

While some women may be hesitant to seek professional help during this period, it’s important to know that it’s completely normal to need or want this kind of support after pregnancy loss.

Online support groups

While it isn’t a good idea to get one’s medical information solely from the internet, a lot of women find emotional support after a miscarriage through online support groups. It’s an easy way to find and connect with like-minded people who may be able to relate to how a woman is feeling after this experience.

Offline, in-person support groups

Other women prefer to find in-person miscarriage support groups. These groups encourage women to share their experiences with miscarriage, and they help women connect with each other in spite of their pain. Hospitals and healthcare providers can usually refer women to these kinds of groups.

The experience of a miscarriage varies widely among women. One factor that doesn’t vary, though, is the necessity of support throughout a miscarriage. No matter how early or late a woman is in her pregnancy, and no matter how the miscarriage happens or what kind of emotional impact it has on a woman, it’s important for women to feel supported – both medically and emotionally – during and after this experience.

Sources

• Elizabeth Leis-Newman. “Miscarriage and loss.” APA. American Psychological Association, Jun 2017. Web.
• “Questions about Grief.” NationalShare. Share: Pregnancy and Infant Loss Support, n.d. Web.
• Anette Kersting, MD. “Complicated grief after perinatal loss.” Dialogues Clin Neurosci. 14(2): 187–194. Web. Jun 2012.