TRYING AGAIN AFTER A MISCARRIAGE
I have first hand knowledge of the devastating effects of a miscarriage. It is heartbreaking and the decision to try again is difficult. Some of us want to try again immediately after the miscarriage to help to ease the pain of the miscarriage itself, or some are afraid to try again because they fear having another miscarriage. I have had two miscarriages in three years, one at 14 weeks and one at 12 weeks. The first miscarriage was brought on by a subchorionic hematoma which started as brown spotting and diagnosed via ultrasound. I started spotting about a week before the actually miscarriage. I was rushed to emergency where the ultrasound found a kicking and alive baby who sadly only had hours of life left. I delivered a tiny baby boy that I could not ever hold or take home.
A subchorionic hematoma or subchorionic bleeding is the clotting of blood between the gestational sac, usually the placenta, and the uterine wall. The reason for a subchorionic hematoma is usually unclear. I had sever hyperemesis, which means I could not control my vomiting. The doctor told me that it was possible that abdominal trauma had caused this. subchorionic hematomas have been shown not only in patients with threatened abortion, but also in patients with bleeding disorders, patients with the presence of auto-antibodies, as well as patients receiving anti- coagulants.
My second miscarriage in May of 2003 was due to an improper implantation. My placenta was not receiving enough nutrients. I was high risk and had weekly appointments. My 11 week appointment showed a live kicking baby, but my 12 week appointments revealed no movement or heartbeat. I had a D&C that very day, however it was incomplete and I started passing large "products of conception" about a week after the D&C. I did get my period back 6 weeks after the D&C. With the first miscarriage with no D&C, I did not get a period for 4 months.
Emotionally you may want to trying again right now or never try again, but physically you should wait at a minimum of one healthy cycle to pass. This means that after your miscarriage you will get a new cycle. Do not try to conceive during that cycle, wait until the next cycle. Some doctors who believe that your uterine lining must take three cycles to get back to rebuilding itself fully each time (especially after a D&C, where it gets scraped pretty thin), most doctors know that it doesn't really matter in about 80% of the cases, and getting pregnant again right away does not carry any increased physical risk or miscarriage risk.
IMPROVING THE UTERINE LINING
RESOURCE: Recurrent Pregnancy Loss
Blood flow to the endometrial lining measured as uterine artery resistance (pulsatility index or PI) and subendometrial flow is under hormonal control and has been shown to correlate with pregnancy outcome. If resistance of flow through the uterine artery is elevated or if flow of blood though the spiral arteries leading to the endometrium is low, successful pregnancy outcome is not expected. Decreased blood flow to the uterus has been shown to be increased and to result in increased successful pregnancy rate with treatment with both aspirin and sildenafil (Viagra).
- Aspirin Therapy
Among women with increased resistance of blood flow through their uterine arteries who were treated with aspirin for a minimum of two weeks, the miscarriage rate decreased from 60% to 15%. An increase in subendometrial flow has also been noted with aspirin therapy. The usual dose of aspirin is 80mg a day (one baby aspirin). However, in an occasional woman as much as 360mg (one adult aspirin) has been required to see a beneficial effect on uterine blood flow. Do NOT go on this therapy without the advice of your physician. - Sildenafil (Viagra) Therapy
When aspirin is unsuccessful in improving uterine blood flow or if the miscarriages are associated with a thin (less than 9 mm) uterine lining, sildenfil (Viagra) has been used successfully to increase uterine blood flow. Viagra in the form of vaginal suppositories given in the dosage of 25 mg four times a day has been shown to increase uterine blood flow as well as thickness of the uterine lining. To date, we have seen significant improvement of the thickness of the uterine lining in about 70% of women treated. Successful pregnancy resulted in 42% of women who responded to the Viagra. It should be remembered that most of these women had previously experienced repeated IVF failures.
More Articles about using Viagra to improve the uterine lining:
I have compiled a list of and bulletin boards for those trying to conceive after a loss that will give you that much needed support:
http://www.pregnancyloss.info/discussion.htm
http://gynosaur.com/phorum/list.php?f=2
Baby Center Trying to Conceive after a loss
Ovusoft Message Boards: Pregnancy Loss Support
Here are some excellent Miscarriage Resources
Immunology may be a key to pregnancy loss
Sperm chromosome defects tied to recurrent miscarriages
Recurrent Miscarriage (Pregnancy Loss)
Recurrent loss linked to gene
Article on recurrent loss and possible causes
Another article on recurrent loss and possible causes
Information on testing for recurrent loss
Late implanting embryos and possibility of miscarriage discussed
Progesterone therapy for pregnancy after loss