DEAR DOCTOR,

I have been trying to conceive after losing my first pregnancy, but it has been over six months now without results. Could it be a problem caused by the previous pregnancy? I am worried.  

DIANA

DEAR DIANA,

I am sorry for your loss. The loss occurred in which month of pregnancy? Was an intervention done to clear the uterus after it?

A miscarriage or abortion usually occurs in the first trimester of pregnancy, i.e. before the foetus becomes viable. It may commonly be due to viral infections, parasitic infections, and trauma to the uterus, hormone imbalance, and chromosomal abnormalities in the fertilised ovum. It can occur so early in the pregnancy, that pregnancy may be missed and bleeding due to abortion may be mistaken for prolonged or irregular menses.  In such a case, one may conceive as early as two weeks after the miscarriage, as the reproductive and hormone system is "tuned” for pregnancy. However, if an intervention has been done, like curettage of the uterus for removing the products of miscarriage, chances of getting pregnant again may be affected. Because the inner lining of uterus may be scarred, preventing implantation of the fertilised ovum. Any damage to the fallopian tube or its inflammation due to infection may hamper conception, as transportation of the ovum to meet the sperm during intercourse and transporting the fertilised egg to uterus is done by the fallopian tubes. Sexually transmitted diseases also cause inflammation and scarring of fallopian tubes, thus resulting in difficulty in getting pregnant.

Loss of pregnancy in later months, commonly occurs due to high blood pressure, infections, chromosomal abnormalities, congenital abnormalities in the uterus. Uncontrolled high blood pressure is a risk factor for miscarriage as well as intra uterine foetal death. It can also cause infertility by reducing blood supply to the uterus and tubes, thus preventing efficient functioning. High blood glucose damages the nerves, as well as blood supply of the uterus, thus affecting fertility. It also increases risk of infection, which can result in infertility. Obesity may be associated with these two conditions, which causes hormonal imbalance and prevents conception. One may tend to become obese after a miscarriage, due to lack of exercise, depression, over indulgence in food, etc. factors, thus reducing chances of fertility. Anti-depressant drugs can also affect fertility.

You should not be worried or become depressed. At times, mental stress can result in spasm of the fallopian tubes, thus prevent conception. Try to find out the period of ovulation (time when an egg is released from the ovary) and plan intercourse in this time. This can be determined by recording morning oral temperature and even by serial ultrasound examination.  Take a balanced diet with more of leafy vegetables and whole grains. Regular exercise and adequate relaxation are beneficial. 

Try these measures for at least six months. If needed, then investigations can be done for detecting any underlying treatable cause for secondary infertility and necessary treatment be taken.  

Dr. Rachna Pande, Specialist internal medicine E-mail rachna212002@yahoo.co.uk