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.

Factors that affect irregular menstruation after miscarriage

The first menstrual period after a pregnancy loss can be different from a woman’s normal period, and it can also be quite delayed. It’s also common for women to notice some spotting for four or more weeks after a miscarriage, so it’s important to recognize what is a menstrual period, and what is intermittent bleeding.

Two factors in particular influence a woman’s period after she has a miscarriage.

• Hormone levels: In the beginning of pregnancy, the placenta starts producing human chorionic gonadotropin (hCG), a hormone that helps the body support a fertilized egg. The purpose of hCG is to stimulate progesterone hormone secretion from the ovary. Progesterone helps maintain a pregnancy and prevents menstruation from occurring. After a miscarriage, hCG production declines because the placenta is no longer present, resulting in a decline in progesterone levels. Menstruation resumes once a woman’s hCG levels are back to zero.
• Length of gestation: If a woman experiences miscarriage early on in pregnancy, she’ll likely start menstruating again sooner than someone who miscarries later in pregnancy. The body needs a certain amount of time to heal depending on how far along the pregnancy was.

What is menstruation like after miscarriage?

Characteristics of menstruation can vary greatly from woman to woman after a miscarriage. The first period after a miscarriage is often heavier than what women normally experience. It also might cause noticeable cramping, and be slightly more clotted than usual. Some women, however, experience a first period after a miscarriage that is lighter than normal and cramp-free.

When can women start trying again?

In the past, healthcare providers have recommended waiting three or so months after a miscarriage before trying to conceive, but recent research supports the idea that it’s healthy to conceive in the cycle after a miscarriage as long as the woman is medically recovered and psychologically ready. Different healthcare providers will have different opinions on when it’s safe and healthy to try to conceive again, so you should ask your provider for their opinion.

Managing emotions during this time

Women cope with miscarriages in a variety of ways, and feeling confused after a miscarriage is very common. Some want to start trying again right away, while others feel extremely apprehensive about another pregnancy. There is no right or wrong way to feel. It is important for women to understand that they are not alone and seeking support from a partner, friends, or family during this time can be very helpful. Women who are more comfortable opening up to a professional may want to consider asking their heathcare providers for mental health counselor recommendations.

It may be difficult to express how you are feeling, but isolating oneself or blaming oneself can make the grieving process more difficult in the long run. Many partners of those who experience pregnancy loss also go through emotional difficulties, which can present in different ways. Having an honest conversation with your partner about how they’re feeling can be a helpful way to get everything out in the open, and allow you to better empathize with one another about the experience.

The bottom line: Things to know

It takes some time to physically recover after a miscarriage. What is considered a ‘normal’ recovery from miscarriage can range greatly – some women do not spot at all afterwards, while others may experience spotting for four or more weeks after. There are also a few different factors that affect when a woman will start menstruating again. Some women start menstruation again as early as four weeks after their miscarriage, while others take longer. Regardless, weekly checkups or a two- or six-week checkup after the miscarriage is usually recommended, depending on the individual situation, to help women and their providers ensure a healthy physical and emotional recovery.

Sources

• Bonnie Gibbs Vengrow. “Irregular Periods after Miscarriage: What You Need to Know.” Parents. Meredith Corporation, 2014. Web.
• Check Pregnancy Staff. “Period After a Miscarriage – 5 Things You Should Know About.” CheckPregnancy.com. Check Pregnancy, Aug 18 2015. Web.
• Fernanda Moore. “Healing After Miscarriage.” Parenting. Meredith Corporation, 2014. Web.

The details behind conceiving after an ectopic pregnancy

There are several variables that factor in to a parent’s chance for conceiving after an ectopic pregnancy.

Physical recovery

Different healthcare providers may have different recommendations depending on each woman’s individual health history, but many healthcare providers suggest waiting at least three months before trying again after an ectopic pregnancy. This allows the body to heal from the following potential effects of an ectopic pregnancy:

• Disrupted menstrual cycle: Menstrual periods will have stopped during pregnancy, and can take a few weeks or months to restart after the pregnancy ends. Once the hormones that control the menstrual cycle are back to their pre-pregnancy levels, the menstrual cycle will resume, and conception is once again possible.
• Scar tissue in the fallopian tube: Though not always, an ectopic pregnancy often involves the egg implanting in a fallopian tube, rather than travelling down the tube and implanting in the uterine wall. Because of this, after an ectopic pregnancy there can be damage to the fallopian tube, whether it’s from the pregnancy’s growth, the procedure to remove it, or from something that contributed to the ectopic pregnancy such as an untreated STD. Scarring in the fallopian tube can interfere with future attempts at pregnancy, so it’s important for these scars to heal before a woman tries again.

Mental recovery

Women vary greatly in their response to pregnancy loss. Some women don’t need any time at all before attempting pregnancy again, while others need time to recover mentally after a loss. It’s not uncommon for the expectations of pregnancy combined with the pain of loss to make women hesitant about trying again. In these cases, it’s wise to take some time off before trying again.

Part of mental recovery involves knowing that after experiencing an ectopic pregnancy, the odds of having another ectopic pregnancy are slightly higher – about one in 10. Many women go on to have a healthy pregnancy, but it’s important to know that your risk of future ectopic pregnancies may be higher than the average woman’s risk.

Even after your healthcare provider gives you the go-ahead on the physical side, it’s very normal to want to wait a bit longer before trying again.

Before you start

The success of a future pregnancy depends on what caused the ectopic pregnancy, as well as your medical history. Before you start trying again, you will want to see your provider for a checkup, where he or she can confirm that your body is ready to sustain another pregnancy.

You might be advised to try conceiving naturally, or your provider might recommend that you try in vitro fertilization (IVF) or another form of assisted reproductive technology, particularly if you have tubal damage or have experienced multiple ectopic pregnancies. If your fallopian tubes aren’t damaged and your ectopic pregnancy was treated early, the odds of a successful and healthy pregnancy are roughly 66%.

The importance of staying healthy

The causes of ectopic pregnancy still aren’t completely clear, and it may be that multiple causes combine to contribute to the development of an ectopic pregnancy. In most cases, an ectopic pregnancy happens due to factors that are out of a woman’s control. But as is the case for all women who are trying to get pregnant, when you’re ready to start trying again, make sure that you take care of yourself and your health. This includes eating a healthy diet, avoiding alcohol and tobacco, decreasing your stress as much as possible, and getting regular exercise. These behaviors can all improve fertility and help reduce some of the risk factors that contribute to pregnancy complications.

Sources

• Richard Sherbahn. Pregnancy After Tubal Ectopic Pregnancy: Getting pregnant after an ectopic.” AdvancedFertility. Advanced Fertility Center of Chicago, 2016. Web.
• Judy Bliss. “Healthy Outlook: Don’t give up after tubal pregnancy.” CCHealth Contra Costa Country Health Services, Jun 6 2012. Web.
• Marissa Selner and Rachel Nall. “Who is at risk for an ectopic pregnancy?” Healthline. Healthline Media, Oct 13 2015. Web.

How smoking might impact fertility

While there are definitely smokers who conceive every day, according to the American Society for Reproductive Medicine, infertility rates in both male and female smokers are about twice what they are in non-smokers who are trying to conceive.

Cigarette smoke can damage and kill off eggs, as well as decrease sperm quality, sperm count, and sperm motility, which is sperm’s ability to move until it reaches the egg. This means that women who smoke may go through menopause one to four years earlier than women who don’t, and that the sperm of men who smoke is far less likely to fertilize eggs. Smoking can also make IVF treatments for infertility less effective, and after conception, women who smoke are also more likely to miscarry or have ectopic pregnancies.

Having your fertility as a reason to quit smoking isn’t necessarily going to make quitting any easier, but your healthcare provider may be able to suggest a program that could. Once you’ve quit, be sure to balance your nutrition, eat lots of antioxidant-rich food, and consider starting to take a multivitamin to get your body more prepared for conception, pregnancy, and labor.

Sources

• “Smoking and infertility.” Reproductivefacts. American Society for Reproductive Medicine, 2014. Web.

Here are the TTC acronyms you should know about

AF:

Aunt Flow. Your period.

Thanks for the invite, but my Aunt Flow’s in town. I’m gonna go home and treat her to some wine and reruns.

BBT:

Basal Body Temperature. BBT may spike right before ovulation, so many women track it to help them pinpoint their ovulation.

The very first thing I did this morning was grab my thermometer and take my BBT.

BCP:

Birth Control Pills.

In almost no time after I stopped taking BCP, I was pregnant.

BD:

Baby Dance. Sexual intercourse, usually done on the most fertile days of your cycle. (Can also mean baby dust, which is a phrase you use to wish someone good luck.)

My ovulation test is positive, which makes me want to dance – the BD, that is!

BFN/BFP:

Big Fat Negative/Big Fat Positive (on your pregnancy test).

Every time I buy a pregnancy test, I think about how it could be the one to show the BFP.

BOB:

Baby on the Brain!

I’m having a hard time shopping with BOB. All I can think about is tiny socks and pacifiers, which makes it impossible to keep track of my grocery list.

CD:

Cycle Day. A specific day in your menstrual cycle (or fertility treatment cycle). To track it, start by counting from the first day of your last menstrual cycle.

It varies each cycle, but normally I ovulate on CD 13, or 13 days after the first day of my period.

CM or CF:

Cervical Mucus or Cervical Fluid. Changes in cervical fluid indicate that a woman is at different stages of her cycle.

At the most fertile point of each cycle, my CM is clear and super stretchy.

CP:

Chemical pregnancy. A very early miscarriage.

My doctor recommended that I put off trying again until one cycle after my last CP.

DD:

Darling daughter. A daughter you already have.

DH, DD, and I go on vacation next week.

DH:

Dear husband.

I’m 42 and DH is 43.

DPO:

Days Past Ovulation, or Cycle Date Post Ovulation.

By 7DPO of the TWW, I’m already wondering if every little cramp is a sign of pregnancy.

DS:

Darling son.

It’s a challenge to care for DD and DS while also TTC.

ENDO:

Endometriosis. A chronic disease in which tissue that is supposed to grow in the uterus grows outside of it. Millions of women experience this condition and it can affect fertility.

After getting diagnosed with ENDO, I was able to find a huge and supportive online community of other women who had the same condition.

EWCM:

Egg White Cervical Mucus. When your cervical mucus looks like egg whites, it may mean that you’re at your most fertile point.

Nothing is as exciting as seeing EWCM when TTC!

FMU:

First Morning Urine. Most pregnancy tests require that women take them the very first time they pee in the morning. In the morning, urine typically has the highest concentration of Human Chorionic Gonadotropin, or hCG, an early pregnancy hormone.

I tested with FMU and got a faint BFP.

FP:

Follicular Phase. The phase of the menstrual cycle when follicles mature in the ovary. This phase begins on day 1 of your period, and ends with ovulation.

I’m so excited to try and get pregnant, I just want my FP to be over!

hCG:

Human Chorionic Gonadotropin. A hormone produced during early pregnancy that helps the baby grow.

I had a positive test, which means there was enough hCG in my urine to detect a pregnancy.

HPT:

Home Pregnancy Test. A pregnancy test that you can take at home. This morning my HPT showed a BFP – but I’m going to my doctor’s to take a blood test to confirm.

IUI:

Intrauterine Insemination. A specific kind of fertility treatment where sperm is placed directly into a woman’s uterus during ovulation.

After 2 years of TTC, we’ve decided to try IUI.

IVF:

In Vitro Fertilization. A procedure in which an egg is fertilized in a lab and then implanted.

We went through several rounds of IVF before getting a BFP.

LMP:

Last Menstrual Period. The first day of your last period.

I started my LMP on June 6th.

LPD:

Luteal Phase Defect. If the corpus luteum didn’t form properly, a luteal phase defect may occur, causing a short luteal phase. This can make it hard for a woman to get pregnant.

I’ve been really accurate with my charting, because I suspect I might have LPD and I want to have a lot of information to show my provider.

LSC:

Low Sperm Count. Commonly the cause of male infertility.

A semen analysis showed that my partner has an LSC.

M/C:

Miscarriage.

I got my first BFP a year ago, which ended in a really upsetting MC.

MF:

Male Factor Infertility.

To help with the MF issues, we found an infertility counselor who was covered by our insurance.

NTNP:

Not trying for pregnancy, not preventing pregnancy.

I just stopped taking BCP, so I guess that we’re NTNP.

O or OV:

Ovulation.

I O’ed on CD15 and BD on days 13 and 15.

OPK or OPT:

Ovulation Predictor Kit or Ovulation Predictor Test. These tests tell you when your body has a surge of luteinizing hormone (LH), which indicates the onset of ovulation.

I just got a positive OPK, which means BD as soon as possible!

PCO, PCOS, or PCOD:

Polycystic Ovaries, Polycystic Ovary Syndrome, or Polycystic Ovary Syndrome Disease. A condition in which a woman’s levels of estrogen and progesterone are unbalanced. Women with PCOS develop cysts on their ovaries, and the condition can cause infertility.

My doctor thinks I have PCOS, so I’m waiting to hear back about my blood work.

POAS:

Pee On Stick. Taking a pregnancy test (peeing on a stick), usually at home.

I’m 7DPO and it’s so hard to wait to POAS!

RE:

Reproductive Endocrinologist. A type of fertility specialist.

I’m meeting with an RE tomorrow to go over my fertility test results.

SA:

Semen Analysis. This is a test that providers can use to determine the quality and quantity of a man’s sperm.

The results of his SA show he has low sperm count, low motility, and poor morphology.

SO:

 Significant other.

My SO and I have decided that next month we’ll start TTC.

TWW or 2WW: Two Week Wait. The time period between when you ovulate and can take a pregnancy test.

 just started my TWW and I need to find some ways to distract myself!

TTC:

Trying to Conceive.

I haven’t decided who I want to tell that we’re TTC.

U/S:

Ultrasound.

Our first U/S is scheduled for the end of the month.

Treatments for depression while trying to conceive

One of the hardest things about depression is that it sounds just like the voice in your head, and it can be convincing – but what it says isn’t in line with the truth. If you’ve been struggling with depression while TTC or if this is your first time experiencing it, you might have had some of the following thoughts, all of which feel totally real but are actually your depression speaking.

• I’m not meant to be a mother
• I don’t deserve to be pregnant anyway
• Something is wrong with me
• I did something wrong
• I’ve failed myself/my partner/my family
• I’m useless because I can’t get pregnant and raise a child
• Everyone is better off without me being a parent

The truth is, these thoughts stem from your depression and aren’t correct in the least. In reality, your TTC journey doesn’t say anything about who you are as a person. Nor does it say anything about what is meant to be or what you and your family deserve. It’s important to be able to recognize these thoughts for what they are so that you can start working on improving your mental health.

Therapy for treatment

Sometimes a provider will ask you to try talk therapy, especially if this is your first experience with depression. One kind of talk therapy, called Cognitive-Behavioral Therapy, has been proven to be particularly helpful while TTC. Cognitive-Behavioral Therapy is a type of talk therapy that helps people identify certain unhealthy thoughts (like the ones above) and change them, slowly over time. Your provider might ask that you see a mental health professional by yourself, or that you attend group therapy sessions.

According to a statement from the Office on Women’s Health in the U.S. Department of Health and Human Services, studies have shown that people who undergo talk therapy during infertility treatments were more likely to get pregnant than those who didn’t go to talk therapy. So there is some evidence to support that therapy can actually increase your chances of conceiving.

Antidepressants for treatment

Your provider might prescribe you antidepressants. Whether or not you are prescribed them will depend on a number of factors, all of which your provider can assess, but there’s no doubt that for some people medication is extremely beneficial in helping with depression.

• Safety: It’s completely understandable that you’d be wary about the effects of antidepressants. While research on antidepressants during pregnancy is limited due to the fact that it’s unethical to experiment with such thing, enough research is out there to show that certain medications have little to no effects on a developing fetus. These include fluoxetine (Prozac), sertraline (Zoloft), or paroxetine (Paxil).
• People who are already on antidepressants: For people who are already on antidepressants, if they’re on one that has safety concerns during pregnancy, their provider may have them switch to an antidepressant that is safer.
• The bottom line: Medication is enormously helpful for many people, and depending on various factors, it could also be helpful for you. Some antidepressants have more research to support that they’re safe to use while TTC and also during pregnancy. Don’t stop or switch your medication until you speak to your provider, as they can help you weigh the risks and benefits of a change.

In addition to treatment: Things that can help

Medication and therapy are without a doubt the most important options to consider when treating depression. And there are other things you can consider doing to support your mental health on a day-to-day basis.

• Take time to regularly focus on yourself. Ask yourself what you need, and then make a point to meet that need.
• Find positive things to do when you notice yourself exhibiting signs of depression.
• Stay aware of your mental and emotional state. If something is causing you anxiety, worry, or sadness, be mindful of the fact that whatever it is might not be the best choice for you.
• Get regular physical activity.
• Rely on your support system. Reach out to a partner, friends, or a family member to create a small community that you can rely on for different things.
• Try to avoid mood-altering substances. It probably doesn’t come as a surprise that depressed people tend to seek out these things. But the health risks that come with alcohol and drugs, and also prolonged exposure to either, aren’t worth it in the long run. Not only is it unsafe to drink while taking antidepressants, mind-altering substances like alcohol actually tend to enhance depressive feelings.

Depression is serious, common, and sometimes, a long-term illness that can impact parents trying to conceive. It can be hard then to remember that depression is a treatable illness, but it is treatable. And starting getting treated for depression will make a world of difference in a TTC journey.

Sources

• Mayo Clinic Staff. “Cognitive behavioral therapy” Mayo Clinic. Mayo Foundation for Medical Education and Research, Feb 23 2016. Web.
• “Depression” ADAA. Anxiety and Depression Association of America, Aug 2016. Web.
• “Major Depression Among Adults.” NIMH. National Institute of Mental Health, 2015. Web.
• Daniel K. Hall-Flavin. “Why is it bad to mix antidepressants and alcohol?” Mayo Clinic. Mayo Foundation for Medical Education and Research, Jun 12 2014. Web.

What to know about getting pregnant again

There are many variables that factor into a parent trying to conceive for a second time. Here are some scenarios to consider.

The easy way

Some individuals who had a particularly difficult time conceiving their first child report having a much easier time becoming pregnant the second time around. This could be for multiple reasons, ranging from just a lack of stress about conception, as they already have conceived their first child, to the fact that pregnancy hormones can help with endometriosis, which can hurt fertility. And other times, it’s just plain luck.

The hard way

On the other hand, even if you had a relatively easy time conceiving the first time around, becoming pregnant with your second child could take more time. For one thing, this time you’re trying to conceive as a parent, and your schedule may be much more hectic than it was the first time around. You may be more stressed (which doesn’t help with fertility), you may have less time to relax, and you may have less time alone with a partner. You’re also a bit older than you were the last time you tried, which could have an effect on your fertility.

Secondary infertility – which is difficulty conceiving a second child – is actually fairly common, and rates of this have increased moderately between 1990 and 2010, according to a study in PLOS Medicine in 2012. Secondary infertility is treatable by fertility specialists, who recommend seeking help on a similar timeline as when trying to have a first child: a year if you’re under 35, or six months if you’re older than 35.

Back to basics

Just like the first time around, making sure your general health is strong is a great place to start in boosting your fertility. Sticking to a nutrient-rich diet that includes folate and omega-3s is also a good idea, as is getting a moderate amount of exercise.

And while it’s definitely not impossible to get pregnant while breastfeeding – and many people certainly have great success doing so – nursing when you’re trying to conceive can decrease fertility and could delay conception. So you should consult with your healthcare provider about the best time to get back in the babymaking game and what breastfeeding might mean for your fertility.