Fertility after a loss

Families who are considering trying to conceive again after a loss often have questions about when they should start. There are several important factors for families to consider, including whether the partners are mentally and emotionally ready to try to conceive again. Another of these factors is medical health, such as your own health, or the health of a future baby. Many families want to know:

If we try to conceive again soon after a loss, is a new baby more likely to die in miscarriage, stillbirth, or infant loss?

The short answer:

If your medical care provider tells you to wait a certain amount of time before trying to conceive again, ask them for more information about how they came to that amount. Sometimes, these are very clear, research-based recommendations that are important to follow because of medications or your health.

If there are no medical reasons to delay trying to conceive again, trying again as soon as immediately is generally supported by the evidence. 

The long version:  

There is some important research out there on what’s called “ideal IPI after loss”. IPI stands for Interpregnancy Interval – the spacing between pregnancies. The ideal IPI is the estimated amount of time between pregnancies that would be most medically beneficial. (Please note here that a time that is medically beneficial may be emotionally or financially unsustainable. As I noted above, these are very important considerations families have. But the following research is only looking at the medical realities families face.) 

Different medical situations come with different ideal IPIs. For example, if you take methotrexate after an ectopic pregnancy, we know of a potential risk for any baby conceived within a few months of that medication; best practice for providers is to recommend you wait 3-6 months to make sure that the medication (which can be harmful to a newly conceived baby) has worked its way out of your system (Bigelow & Bryant 2015). Or, if you are taking a particular antidepressant that is not safe for pregnancy, your provider may advise you wait or switch to a safer antidepressant if you want to try to conceive. Or, if you have a uterine infection after your loss, your body may need to heal from that before trying to conceive would be advisable.

But, if there are not clear medical reasons why waiting is important, when medically can or should someone try to conceive again? 

Let’s start by discussing trying to conceive after a miscarriage. There’s a common myth that you should wait at least three months after a miscarriage to conceive another child to increase that next child’s odds of survival. The idea behind this is that uterine lining or nutrient levels could be less than ideal just after a loss, making it difficult to sustain another pregnancy. However, this is not a research-based recommendation. Research does not show a difference obstetric outcomes depending in waiting or not waiting 90 days/three months (Wyss et al 1994; Wong et al 2014; Tessema 2002), or in waiting or not waiting 100 days (Goldstein et al 2002). 

In fact, sooner might be better for IPIs after a miscarriage. One study found that conceiving within 6 months of a miscarriage resulted in better obstetric outcomes than conceiving between 6 and 12 months after a miscarriage (Love et al 2010). Three others found that conceiving within 3 months of a miscarriage resulted in better obstetric outcomes than conceiving between 3 and 6 months or 6 and 12 months (DaVanzo et al 2012; Schliep et al 2016; Sundermann et al 2017). And, in strongest evidence, a meta-analysis (a study of a bunch of studies) found that the risk of a second miscarriage was lower when the IPI was less than 6 month (Kangatharan et al 2017).

What about after a stillbirth

The research on ideal IPIs after stillbirth is more mixed than after miscarriage. One recent study found no difference in adverse perinatal outcomes across any IPI (including the category marking less than 3 months) (Gibbons et al 2023). A team of authors found in one study that there was no difference in subsequent pregnancy outcomes by IPI but, in another study focused on infant loss rather than pregnancy outcomes, that there was a difference (that, after a stillbirth, an IPI of less than 15 months was associated with more risk of the second baby’s death between birth and their first birthday) (DaVanzo et al 2007; DaVanzo et al 2008). Other studies have found differences but not statistically significant differences amongst different IPI groups after a stillbirth (Getahun et al 2009) and between a group where the IPI was less than 12 months compared to more than 12 months (Regan et al 2019). Scholars have pointed out that these data can be confusing because maternal age is so different among people with short and long IPIs, so we need more research to truly understand any impact of IPI on pregnancy and infant mortality outcomes after stillbirth (Bigelow & Bryant 2015). 

Overall, research does not give us a clear recommendation on ideal IPI after stillbirth. In other words, there is not a general consensus that any time frame is too early to try to conceive again. 

Gathering information

As you discern whether to try to conceive and if so, on what timeline, there are a few key questions I encourage you to ask your medical provider:

“Are there any medical reasons I should avoid pregnancy right now?”
I suggest you ask it this way even if you are not planning to try to conceive soon or are undecided, because this wording underscores the timing and medical nature of the question (telling the provider exactly what you want to know). It can also open up a conversation if your provider is making recommendations for non-medical reasons, such as concern about your mental health.

“What are my risk factors if I were to get pregnant in the next few months?”
This phrasing helps your provider understand that you want to discuss risk factors specifically. Your provider’s answer may also help you understand whether they are giving medical or non-medical advice, or research-based or non-research-based advice.

And, if the provider gives you a recommendation, “Can you tell me more about that recommendation?”
This communicates to your provider that you want more information and gives them the chance to walk you through their thinking. They can then tell you if they are making a recommendation based on research, anecdote, or assumptions.

Remember that you can always practice these conversations with a support person beforehand, or bring a support person to a medical care appointment.

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