Struggling to Get Pregnant After a Miscarriage

Once you've decided to try again after a miscarriage, the time it takes until you are pregnant again may feel like forever, even if you end up conceiving very soon. For couples who don't conceive right away, the wait can be unbearable.

Still, given that the odds of getting pregnant in any particular month are only about 30% to 40% , even when you have sex during your fertile days, it's not necessarily a sign that anything is wrong if it takes a little bit of time to conceive again.

If You Have Trouble Conceiving

If you've been trying to get pregnant for several months without any success, you may want to speak with a fertility specialist or reproductive endocrinologist.

You can check in with your doctor sooner if you are not conceiving and have a specific concern, such as if you have irregular menstrual periods. If it took you a long time to conceive the pregnancy that you miscarried, it may also make sense to speak with a fertility specialist sooner rather than later.

There are a number of possible reasons for not getting pregnant. These include: 

• Bicornuate (heart-shaped) uterus or other uterine anomaly
• Blockage in your fallopian tubes
• Difficulty with ovulation
• Endometriosis—a reproductive condition which can cause chronic pain and infertility
• Genetic issues related to fertilization
• Issues with your partner's sperm 
• Unexplained infertility—sometimes infertility occurs without any known causes 

If you cannot get pregnant, a reproductive endocrinologist or gynecologist with knowledge of infertility can help diagnose these issues. 

Infertility Treatment

The options for treating infertility are varied and complex. Often, the first step is to stimulate the ovaries using fertility drugs, like Clomid (clomiphene citrate), Femara (letrozole), or injectable hormones like FSH. This treatment is combined with timed insemination.

The most notable effect of ovarian stimulation is multiple pregnancies. Specifically, a 2012 study suggested that 28.6% and 9.3% of mothers undergoing ovarian stimulation experienced twin and higher-order pregnancies, respectively.

The rates are lower with Clomid, with a 10% chance that a successful pregnancy will be twins or a higher-order pregnancy. Multifetal gestation can be concerning, and currently, researchers are trying to figure out how to maximize pregnancy rates while minimizing multifetal gestation.

Other treatment options include intrauterine insemination (IUI), male fertility treatment, or surgery (for example, to remove fibroids or correct uterine abnormalities). If treatments like these do not result in pregnancy, in vitro fertilization (IVF) may be the next option to explore.

Less commonly, IVF is the first step. It can be necessary in cases of severe male infertility or in women with blocked fallopian tubes. With IVF, eggs and sperm are joined in a laboratory dish. Then, about 3 to 5 days after conception, fertilized eggs are transferred back to the uterus. As with other forms of assisted reproductive technologies, IVF can also result in multifetal gestations.

In an attempt to curb the chance of multifetal gestations, the American Society for Reproductive Medicine revised their recommendations regarding the number of embryos that should be transferred to women younger than 35 years old with favorable prognoses. The new recommendations limit the number of embryos transferred to just two embryos.