Thanks to advancements in technology and progressive policies, women today have the power to take control of their fertility. However, even with all the support and options available, getting pregnant can still be quite the challenge for some couples, including facing a miscarriage.
“About 25 per cent of pregnancies in the first trimester will end up in a miscarriage,” says Dr Liu Shuling, senior consultant from the Department of Reproductive Medicine at KK Women’s and Children’s Hospital.
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The most common cause for miscarriage in the first trimester is an abnormal number of DNA in the pregnancy itself. Typically, a woman going through miscarriage in the first trimester for the first time would not be tested. “However, if the patient is undergoing a miscarriage for the second time in the first trimester, she can consider testing the DNA of her pregnancy,” says Dr Liu.
Depending on the results, the doctor will perform more investigations to determine the possible cause. Dr Liu highlights that most patients with recurrent miscarriages have unknown causes that are unexplained – more than 50 per cent of patients with three or more miscarriages will end up showing normal results despite extensive investigations.
Miscarriages in the second and third trimesters of pregnancy are less common. Some possible causes include severe fetal abnormalities and poorly controlled medical conditions like diabetes and high blood pressure. A thorough check on the fetus and placenta, as well as blood tests, can be conducted to identify the cause of miscarriage.
Ultimately, the most important thing to do after a miscarriage is to rest and recover, advises Dr Liu. Once your menstrual cycle resumes, you can always try again. A normal menstrual cycle typically resumes four to six weeks after the miscarriage. Women who are keen to conceive again can try after their menstrual cycle resumes. “Stay positive, even if you had a miscarriage, your chance of having a successful pregnancy is still very high,” adds Dr Liu.
If you have been through a miscarriage and are looking to conceive again, here are some tips that may help increase your chances:
As your body is a sanctuary for your baby, keeping it healthy is key. Ensure you maintain a healthy lifestyle through exercise and good weight management. It’s also beneficial to avoid smoking, and excessive alcohol and caffeine intake.
A healthy body needs a healthy mind as stress can also affect you. “Managing stress levels with open communication and trust in the relationship, and sharing expectations with your spouse are also important. Focus on building your relationship too, and enjoy doing activities together instead of just focusing on the babymaking,” says Dr Janice Tung, consultant obstetrician and gynaecologist from Thomson Fertility Centre.
Apart from a healthy lifestyle, it is also crucial to be aware of your fertility health. Couples can get a basic fertility health check. This entails blood tests, and an ultrasound scan for women and semen analysis for men. “Time is of the essence when it comes to fertility due to the decline in egg and sperm quality with age,” says Dr Tung.
A fertility health check helps identify contributing factors and eliminate any conditions that could prevent or delay a healthy pregnancy. Dr Tung says: “There is no exact cut-off age and any couple considering plans for starting a family can get checked. In general, for younger couples in their 20s or early 30s, they may actively try for up to a year before seeking help, and for couples in their mid-30s and above, up to half a year.”
If it is detected early that a couple has problems such as fibroids, endometriosis or low sperm count, the doctor can prescribe more effective treatment plans to increase their chances of pregnancy.
Dr Liu adds: “Getting sunlight to achieve sufficient vitamin D will also enhance fertility health. Folic acid should also be taken while trying for pregnancy and it is best to start before pregnancy.”
Those with difficulty conceiving the traditional way can consider alternative methods of conception such as Intrauterine Insemination (IUI) and In-Vitro Fertilization (IVF).
IUI involves placing your partner’s processed sperm sample inside your uterus to facilitate fertilisation with the egg. Oral medication and injections can be used to stimulate ideally two to four eggs when a woman nears ovulation. The aim is to get the sperm as close as possible to the egg to increase the chances of pregnancy. After that, it’s up to nature to take its course.
IVF on the other hand, is a procedure in which an egg is fertilised with sperm outside the body, typically in a laboratory dish, and then implanted in the uterus. This is recommended for women with blocked fallopian tubes and men with moderate to very low sperm count. “It is essentially an accelerated means of trying for pregnancy because it bypasses natural fertilisation”, says Dr Tung, who is also an IVF specialist.
Dr Tung recommends IVF for women nearing or over 40, or who have a long duration of unexplained infertility as egg quality declines with age. For younger women with a shorter duration of unexplained infertility, from around less than one or two years, they may consider some cycles of IUI, and move on to IVF if there is no success.
According to statistics from Thomson Fertility Centre, the chances of pregnancy through IUI are 18 to 20 per cent while IVF has higher chances of 35 to 50 per cent. However, there is still the possibility of miscarriage with an IUI or IVF. The most common reason is that the embryo or pregnancy was genetically abnormal in the first place.
“Fertility treatments should not be considered a magic bullet to get pregnant,” stresses Dr Tung. She advises couples to keep trying to conceive naturally alongside the treatments. As for those who have been actively trying to conceive for six to 12 months without success, they should go for a fertility health consultation.
Aside from this, there may be underlying unknown or untreated conditions such as hypothyroidism or diabetes if not already screened for before pregnancy. An overactive immune system with conditions such as lupus or clotting disorders may also contribute to miscarriage. Your doctor may recommend testing for such conditions after one or more miscarriages.
No matter which stage of your fertility journey you are at, it’s important for you and your spouse to have honest and open communication with each other.
Dr Liu encourages couples to be supportive of their spouse. “Being supportive not only helps strengthen a relationship, but also helps with overcoming the loss and moving on and getting pregnant,” she says. For those farther along on their fertility journey, it is also important to understand the processes and the potential risks involved.
Regardless of these, Dr Tung stresses the importance of having open communication between spouses. Apart from that, she highlights that couples should also have an open and comprehensive discussion with their specialist on the processes, risks and chances of success.
Resources and forms of support are available to help couples on their journey, such as the Facebook Group Fertility Support Group Singapore by I Love Children. The group was created to offer emotional support and education for couples trying to conceive, and members can expect tips and advice, event updates, along with other useful information related to fertility.
Visit this website for more information on fertility health.
An I Love Children special brought to you by The Singapore Women's Weekly
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